Around 400,000 cataract operations are performed in the UK each
year, and effective pupil dilation (mydriasis) is a required step prior to surgery. An
intracameral (IC) injectable solution of a fixed combination of two mydriatics plus
anaesthetic (ICMA) has been developed to achieve stable, fast onset of mydriasis
with low systemic absorption, in order to reduce dosage errors, long waiting times
and delays before cataract surgery. The objective of this study was to assess the
economic impact of this new ICMA injectable solution compared to the standard
topical dilating eye drops in the UK hospital setting.
A budget impact
model (BIM) compared the economic outcomes associated with utilisation of ICMA
(tropicamide, phenylephrine, lidocaine) versus standard care using eye drops (tropi-
camide, phenylephrine) in patients undergoing cataract surgery. The BIM predicted
health care costs over one year in two situations: patients dilated with intra-operative ICMA injectable solution and patients dilated with eye drops prior to surgery.
Data used to assess resource consumption was taken from randomized clinical
trials, and costs from the British National Formulary.
of ICMA is associated with a slightly positive effect on the hospital organisation
associated with cost savings (including human and material resources) of £2.13
per surgery and £853,000 in one year for the hospitals. The acquisition costs of the
ICMA injectable solution compared to standard care were balanced with substantial
reduction in nursing costs (avoiding multiple drop instillations saving around 29
minutes per patient); surgeon costs, plus lower additive mydriatics requirements
during surgery. This time saving potentially allows increased number of cataract
operations, with associated productivity increases and cost savings.
ICMA injectable solution for cataract surgery offers a promising alternative to eye
drops, permitting improved patient flow and optimization of the surgical schedule,
with associated efficiency benefits.