Femtosecond lasers enable surgeons to perform a more accurate capsulotomy when removing a patient’s lens during a cataract procedure. Traditionally the procedure is performed manually with a phaco emulsifier. These systems cost from $50,000 to $150,000 with consumables ranging from $50 to $100 per patient (not including the replacement lens, IOL). In comparison a Femtosecond laser costs $400,000 to $500,000 with consumables starting at $350. One question budget and value analysis committees ask is: “What am I getting for my money?”
Several vendors currently have received FDA approval, including LenSx® Laser, LensAR Laser System, and Catalys Precision Laser System (OptiMedica). The VICTUS™ Femtosecond Laser Platform is not approved by the FDA. The trade-off of this technology is improved outcomes, as the replacement lens (IOL) fits more precisely in the laser-prepared capsule. According to one recent study, this reduces the possibility of astigmatisms or other vision problems resulting from the lens shifting or being compressed over time. In addition, initial clinical evaluations suggest that the Femtosecond laser allows the surgeon to use less power while performing the procedure more quickly. The end result is less potential for damage to the eye.
Another question that goes hand in hand with cost is reimbursement. Under APC 246, cataract procedures have an average Medicare payment level of $1,650. The more involved anterior procedures have a reimbursement level of $2,117 (APC 249). Based on these reimbursement levels and the projected cost, a facility will have to perform at least 380 procedures per year over a five-year period to break even.