Recent studies have shown that “dropless” cataract surgery, in which patients receive intracameral agents to prevent infection and inflammation, is at least as safe and effective as traditional approaches.

Such procedures, which eliminate the need for patients to self-administer postoperative eye drops (along with the associated dosing and compliance problems), have grown increasingly popular with physicians. Yet little is known about the costs of dropless therapy regimens compared to those of topical medication regimens.

A new study published in the Journal of Cataract and Refractive Surgery from Ravi S. Parikh, MD, MPH, director of healthcare delivery research for NYU Langone Health’s Department of Ophthalmology, and Scott Massa, MD, resident physician in the department, is one of the first to address that question systematically.

“Dropless cataract surgery saves both the system and the patient money, and the data shows dropless techniques provide clinical outcomes that are equal to or better than those of conventional methods.”

Ravi S. Parikh, MD, MPH

“One of the main reasons that physicians hesitate to adopt dropless surgery is that they worry it will be too costly or less effective,” notes Dr. Parikh, the study’s senior author. “We found that it saves both the system and the patient money, and the data shows dropless techniques provide clinical outcomes that are equal to or better than those of conventional methods. That seems like a win-win.”

Cost Analyses

For the study, Dr. Parikh and colleagues obtained cost data for topical postoperative medications from the 2020 Medical Expenditure Panel Survey. Costs for dropless medications were sourced from distributors’ websites and catalogs.

The advantage, the researchers found, went decisively to dropless therapies. The least expensive dropless, injection-based regimen, which includes intracameral moxifloxacin (sourced at 1.6 mg/mL) and subconjunctival triamcinolone acetonide (sourced at 10 mg/mL), costs the healthcare system as low as $15.91 per eye, and patients nothing at all.

In contrast, the least expensive topical medication regimen, consisting of ofloxacin 0.3% and prednisolone 1%, costs the healthcare system an average of $103.90 per eye, with patients paying an average of $43.64 per eye.

These savings, the authors say, could translate to a total reduction in costs of up to $450 million per year to the U.S. healthcare system, and up to $225 million per year to patients.

Disclosures

Dr. Parikh reported receiving consulting fees from Anthem Blue Cross Blue Shield, Regeneron, and Apellis Pharmaceuticals; serving as a consultant for GLG, Health and Wellness Partners, and Axon Advisors; and funding from the American Academy of Ophthalmology (AAO) for AAO-related work with the Relative Value Update Committee.