Comparison of the Cost-Effectiveness of SMILE, FS-LASIK, and PRK for Myopia in a Private Eye Center in Spain

PURPOSE: To describe and compare the cost-effectiveness of small incision lenticule extraction (SMILE), femtosecond laser- assisted in situ keratomileusis (FS-LASIK), and photorefractive keratectomy (PRK) for treating myopia and myopic astigmatism in a private eye center. METHODS: The perspectives for this cost-effectiveness analysis were for the payer and the health care sector. For the payer's perspective, a decision tree model was made, with a time period of 30 years, and the average weighted utility values and quality-adjusted life years (QALY) were computed for each procedure. The average weighted costs were derived for each procedure and divided by the QALY to obtain the incremental cost-effectiveness ratios (ICER). For the health care sector's perspective, the direct and indirect costs of acquiring the equipment and maintaining the facilities-including consumables and personnel salaries-were obtained to compute the minimum number of patients treated per year. RESULTS: The weighted utility values were 0.8 for SMILE and PRK and 0.77 for FS-LASIK. The weighted QALYs were 24 for SMILE and PRK, and 23.1 for FS-LASIK. The average weighted costs were 335.45, 443, and 346.96 euro , respectively. The resulting incremental cost-effectiveness ratios were 13.98 euro /QALY for SMILE, 18.46 euro /QALY for PRK, and 15.02 euro / QALY for FS-LASIK. There was a negative correlation between the ICER and the time (in years) after the surgery. To achieve a profit, the minimum number of patients treated per year is 155 for SMILE, 136 for PRK, and 155 for FS-LASIK. CONCLUSIONS: Laser corneal refractive surgery is cost-effective for a person desirous of refractive correction for myopia. SMILE had the lowest ICER, followed by FS-LASIK and PRK. This trend was noted at all time periods. The cost of investing in laser refractive surgery facilities is outweighed by the potential income in high-volume eye centers.