title: Financial modelling of femtosecond laser-assisted cataract surgery within the National Health Service using a 'hub and spoke' model for the delivery of high-volume cataract surgery.
abstract: To develop financial models which offset additional costs associated with femtosecond laser (FL)-assisted cataract surgery (FLACS) against improvements in productivity and to determine important factors relating to its implementation into the National Health Service (NHS).
  
  
  
  FL platforms are expensive, in initial purchase and running costs. The additional costs associated with FL technology might be offset by an increase in surgical efficiency. Using a 'hub and spoke' model to provide high-volume cataract surgery, we designed a financial model, comparing FLACS against conventional phacoemulsification surgery (CPS). The model was populated with averaged financial data from 4 NHS foundation trusts and 4 commercial organisations manufacturing FL platforms. We tested our model with sensitivity and threshold analyses to allow for variations or uncertainties.
  
  
  
  The averaged weekly workload for cataract surgery using our hub and spoke model required either 8 or 5.4 theatre sessions with CPS or FLACS, respectively. Despite reduced theatre utilisation, CPS (average £433/case) was still found to be 8.7% cheaper than FLACS (average £502/case). The greatest associated cost of FLACS was the patient interface (PI) (average £135/case). Sensitivity analyses demonstrated that FLACS could be less expensive than CPS, but only if increased efficiency, in terms of cataract procedures per theatre list, increased by over 100%, or if the cost of the PI was reduced by almost 70%.
  
  
  
  The financial viability of FLACS within the NHS is currently precluded by the cost of the PI and the lack of knowledge regarding any gains in operational efficiency.
authors.affiliation: Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.|King's College London, London, UK.
authors.forename: H W
authors.initials: HW
authors.lastname: Roberts
authors.affiliation: Division of Surgery, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: M Z
authors.initials: MZ
authors.lastname: Ni
authors.affiliation: Department of Ophthalmology, Guy's and St Thomas' NHS Foundation Trust, London, UK.|King's College London, London, UK.
authors.forename: D P S
authors.initials: DP
authors.lastname: O'Brart
mesh_terms: D002387:Cataract Extraction / Q000191:economics* / Q000379:methods*; D006801:Humans; D053685:Laser Therapy / Q000191:economics* / Q000379:methods*; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom; D016526:Workload / Q000191:economics*