Cost-benefit analysis of a trifocal intraocular lens versus a monofocal intraocular lens from the patient’s perspective in the United States

Abstract

Purpose To conduct a cost-benefit analysis of AcrySof IQ PanOptix trifocal intraocular lens (TFNT00 IOL) versus AcrySof monofocal IOL (SN60AT) from the patient perspective in the United States (US). Methods A de novo Markov model was developed to estimate the mean total lifetime patient costs and vision-related quality of life (measured as quality adjusted life-years (QALYs)) with each intervention (TFNT00 and SN60AT) and the incremental differences between these two treatments. The resulting incremental quality of life gain was mapped to the US patient willingness to pay threshold of $50,000 per QALY gain to estimate the lifetime net monetary value, measured as the net monetary benefit of TFNT00 IOL. Model inputs (transition probabilities, costs, discount rate, utilities, and event rates) were derived from the FDA IDE study (NCT03280108), published literature, clinical experience, and other relevant sources. Results Bilateral cataract surgery with implantation of the advanced technology IOL (AT-IOL) TFNT00 provides improved vision-related quality of life (QALY gain of 0.67) at an incremental lifetime cost of $2,783 compared to monofocal IOL. This incremental QALY gain translated into a lifetime net monetary benefit of $30,941 at the patient willingness to pay threshold of $50,000/QALY gain. Results were most sensitive to disutility due to wearing glasses, patient out of pocket costs for bilateral AT-IOL procedure, and post-operative spectacle dependence rates. Conclusions AcrySof IQ PanOptix IOL provides greater improvement in vision related quality of life compared to no presbyopia correction with a monofocal IOL. This study shows PanOptix is a cost-beneficial treatment strategy for patients willing to pay out of pocket for cataract surgery.

The Royal College of Ophthalmologists’ National Ophthalmology Database study of cataract surgery: report 16, influence of remuneration model on choice of intraocular lens in the UK

“…Centres remunerated by the PbR model were shown to be more likely to opt for a hydrophilic IOL instead of a hydrophobic IOL. The cost of IOLs can vary considerably by the IOL material, design and optical properties, 18 but on average, the hydrophobic IOLs are more expensive than hydrophilic IOLs, though the cost of the same IOL may be different for different centres and is influenced by the volume of surgery and the local discussion and agreement held between the centre and the IOL manufacturer / distributor. Based on the mean cost, the hydrophobic IOLs were shown to be ≈£3 (or ≈7%) more expensive than the hydrophilic IOLs.…”

Cataract surgery after corneal refractive surgery: preoperative considerations and management

“…A recent report by the American Academy of Ophthalmology ( n = 34 studies) has highlighted the efficacy and safety of presbyopia-correcting IOLs, including multifocal and EDOF IOLs, in improving both distance and near visual acuity and spectacle independence after cataract surgery when compared to monofocal IOLs [43]. Berdahl et al [44] further demonstrated the superior cost--benefit and vision-related quality of life of multifocal IOL over monofocal IOL. Nevertheless, presbyopia-correcting IOLs may result in reduced mesopic contrast sensitivity and patient-reported visual phenomena such as glare and haloes, highlighting the importance of preoperative counselling and patient selection [43].…”

Extended Depth-of-Focus Intraocular Lens Implantation in Patients with Age-Related Macular Degeneration: A Pilot Study

“…In patients with normal retinae, multifocal IOLs, such as diffractive trifocal IOLs, have been found to be effective for near, intermediate, and distance vision, but are associated in a subset of patients with dysphotopsia. 3 Several trials have documented a reduction in contrast sensitivity and increase in optical aberration. 4,5 In patients with compromised retinal function, such as those with AMD, multifocal IOLs may further reduce contrast sensitivity to an unacceptable level, and are felt by some to be relatively contraindicated.…”