Cost-Effectiveness Analysis Of Ophthalmic Prostaglandin Analogues For The Management Of Ocular Hypertension And Glaucoma

Abstract

Objectives: evaluate the cost-effectiveness of the use of toric intraocular lenses (IOLs) in surgery of patients with cataract and preexisting corneal astigmatism (> 0.75 D), versus the use of traditional monofocal intraocular lenses (IOLs) from the perspective of third party payer, as a way to define which technology could considered in the health care reimbursement. MethOds: in a decision tree type model was simulated the cataracts surgery intervention in a time horizon of five years. The outcome measure was the cumulative visual acuity of 20/32, which was expressed in normal vision time without additional support. The drug costs were taken from SISMED (2013), the costs from multi-core procedures of the health ministry (SISPRO), the cost of glasses and contact lenses from commercial channel, and the cost of IOLs were taken as the selling price of Alcon Laboratories. Finally a Montecarlo type sensitivity analysis was performed. Results: as primary outcome, time normal distance vision without additional support was higher with toric IOLs, which it were more effective at 3,64 years versus 2,97 years achieved with traditional monofocal IOLs. Intervention with toric IOLs showed in the time horizon of five years be more expensive with (USD) $1.093,55 versus costs of traditional monofocal IOLs (USD) $732,71. In this regard cataract surgery is more effective and more costly with toric IOLs than with traditional monofocal IOLs with an incremental cost-effectiveness ratio of (USD) $534,83 per each year of normal vision without additional support. It was observed that the ICER improves if there is a greater visual impairment due to astigmatism before surgery, as well, to diopters < 1.50, > 1.50 < 2.00 and > 2.00 the ICER was (USD) $ 712.40, (USD) $ 416.75 and (USD) $ 382.16 respectively. cOnclusiOns: toric IOLs proved to be cost-effective for the treatment of patients with cataract and preexisting astigmatism.