Impact Of Yag Laser Capsulotomy Procedures On Cataract Center Chair Time And Revenue Opportunity- A Cost Consequence Analysis At A Private Facility In India

The purpose of the study is to compare the clinic chair time and revenue due to YAG laser capsulotomy and its complications associated with five single-piece hydrophobic acrylic IOLs  (AcrySof, Hoya Vivinex iSert, B&L Envista MX60, J&J Tecnis ZCB00 and Zeiss CT Lucia  ) at a private ophthalmology centre in India, and to explore potential revenue opportunity by reinvesting the YAG procedure chair time to other procedures over 5 years period. 

Private cataract center in India

YAG laser capsulotomy incidence at 5 years and risk probability of post-Nd:YAG laser complications was derived using pooled evidence from published literature. Annual cataract procedures (N=25,000), chair time and center fee for YAG procedure and any subsequent procedures to treat YAG laser complications, chair time and center fee for conducting other ophthalmology procedures (anti-VEGF injection, LASIK, and successful patient counselling on advanced Technology IOL (ATIOL) procedure), were informed by surgeon inputs. Analysis was conducted using cost-consequence approach.

The model demonstrates use of AcrySof IOLs could save chair time (range: 487- 3,334 hours) compared to other 4 IOLs (Hoya Vivinex iSert, B&L Envista MX60, J&J Tecnis ZCB00 and Zeiss CT Lucia) due to lower need for YAG procedures and any subsequent procedures to treat YAG laser complications at the center over 5 years. Our analysis shows although this could lead to the loss of YAG procedure revenue for the center, the saved YAG procedure chair time if re-invested in performing other ophthalmology procedures (Anti-VEGF injection, LASIK or ATIOL counselling), could potentially result in higher overall center revenue (Low end =INR 8.1 million; Upper end=INR 333.8 million).

The probability of performing YAG capsulotomy procedure is linked to the choice of IOL implant and impacts clinic chair time with a limited revenue potential. Choosing AcrySof IOL could reduce the need for YAG procedure and saved chair-time which could be utilized in performing other ophthalmology procedures with higher revenue potential.