Aim: To analyse the cost effectiveness of foldable monofocal intraocular lenses (IOLs) compared to foldable multifocal IOLs in cataract surgery alongside a prospective, multicentre randomised clinical trial (RCT). Methods: Patients underwent cataract surgery with bilateral monofocal (n = 97) or multifocal (n = 93) IOL implantation. Cost data and patient preferences, using the visual analogue scale (VAS), the time trade-off (TTO), and the standard gamble (SG) technique were obtained preoperatively and postoperatively by structured interviews. The incremental costs (multifocal minus monofocal), mean costs per patient, and differences in preferences were computed. Results: Mean costs for glasses per patient in the monofocal group were J41.67 and in the multifocal group J149.58. The difference in costs between the multifocal and monofocal group was J292.09 and was statistically significant (p = 0.008). No significant differences were found in total costs or in effectiveness between the monofocal and multifocal IOL group. Conclusion: The cost effectiveness of multifocal IOLs is reduced to a cost minimisation analysis, because of the inability to demonstrate significant differences in effects. The use of multifocal IOLs in cataract surgery resulted in a significant reduction in costs for patient's postoperative spectacles.M odern cataract surgery enables treatment of cataract and (oncoming) presbyopia in cataract patients.1 An ideal intraocular lens (IOL) would simulate the original function of the crystalline lens and provide the patient with multifocal vision.
1-3Clinical studies have shown improved uncorrected near visual acuity and a decreased spectacle dependency for patients with a multifocal IOL compared to patients with monofocal lens implantation. 4 It is hypothesised that this decreased spectacle dependency results in vision related and generic health related quality of life (HRQoL) differences between patients with monofocal and multifocal IOLs. [5][6][7] Differences in the effectiveness can be related to the possible differences in costs, resulting in a cost effectiveness analysis.Up to now, there is one cost effectiveness study that compares cataract surgery with implantation of bilateral monofocal and multifocal IOLs.8 This study reported the cost effectiveness of each treatment using the healthcare payer perspective and divided the average cost per patient by the proportion of patients experiencing a particular vision related outcome, such as costs per spectacle free patient.A specific type of a cost effectiveness analysis (CEA) is a cost utility analysis (CUA). 9 In a CUA consequences are measured in quality adjusted life years (QALYs). A QALY combines quantity of life (in years) with quality of life (expressed in utilities/preferences) in one measure. A utility is a preference for a certain health state expressed in a cardinal number between 0 (death/worst imaginable health status) and 1 (perfect health/best imaginable health status). The term utility and preference will be used interchangeably in thi...
The purpose of this study was to assess adoption, implementation and maintenance of a guided supermarket tour program of nutrition education by Dutch Public Health Services (PHSs), and the factors associated with program dissemination. A first questionnaire was sent to all 60 PHSs, and measured program adoption, perceived program attributes, and characteristics of the adopting organization and person. A second questionnaire was only sent to adopting PHSs, and measured extent and success of implementation, intentions to continue the program, and characteristics of the main implementing person. Of the 59 PHSs who responded, 30 adopted the program and 17 implemented it sufficiently. Perceived program complexity, social influence within the PHS toward program participation and existence of a separate health education department were predictors of adoption. Perceived program complexity was also a predictor of extent of implementation. The number of health educators within each PHS was a predictor of sufficient implementation. It was concluded that adoption and implementation of the program was reasonable, considering the limited dissemination strategy. Dissemination might have been more successful if the program had been less complex and required less effort, if positive social influence had been generated, and if specific attention had been given to PHSs without a separate health education department.
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