IOL implantation more expensive than contact lenses for congenital cataract

This retrospective analysis found that treating an infant with unilateral congenital cataract during the first year of life costs an average of $4,000 more (37.5 percent) with IOL implantation than contact lenses. However, the issue is complicated and other factors need to be considered.

They estimated the difference in total cost of care between the two treatment arms of the Infant Aphakia Treatment Study. In that multicenter study, patients aged one to six months underwent cataract surgery and were then randomly assigned to be left aphakic and treated with a contact lens or to undergo IOL implantation at the time of cataract extraction.

To avert any site-related bias in terms of cost, they based the preoperative, hospital, surgical, and postoperative costs incurred at each study site on the payment structure of a single third-party payer: Georgia Medicaid. They then combined these costs with the actual costs incurred for postoperative optical rehabilitation services and patching therapy.

The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14,752 versus $10,726 with contact lens correction. The initial cataract surgery accounted for approximately 50 percent of the treatment costs for both groups. Contact lens costs accounted for 15 percent ($1,600/patient) in the aphakic group, whereas the cost of glasses represented only 4 percent ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7,302 vs. $5,357) and the cost of additional operations.

The authors note that part from the increased cost of surgeries related to IOL implantation, costs may also differ on an individual level based on the type of medical insurance used and unforeseen factors, such as the child's tolerance of contact lens wear.

They conclude that cost is one of many factors that should be considered when choosing a treatment option for an infant with a unilateral congenital cataract. Additional follow-up will be necessary to determine the long-term direct and indirect costs of each treatment.