Cost effectiveness of foldable multifocal intraocular lenses compared to foldable monofocal intraocular lenses for cataract surgery

Abstract

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 clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation

“…Dolders and colleagues 101 reported a cost-utility analysis comparing monofocal and multifocal intraocular lenses (IOLs) in cataract surgery in the Netherlands. Patients were randomised to receive surgery with either a monofocal or a multifocal IOL (n = 143 analysed).…”

“…Sach and colleagues 91 also reported a decrease of 0.01 for second-eye surgery compared with a slightly bigger decrease of 0.03 for patients not undergoing second-eye surgery, representing a net 0.02 utility gain. Dolders and colleagues 101 reported decreases in utility of 0.01 to 0.08 from completion of first-eye surgery to completion of second-eye surgery, with estimates varying according to which HRQoL instrument was used. In their study, for first-eye cataract surgery there was an increase in utility for some instruments, no change for other instruments and for some instruments there was a slight decrease.…”

“…Furthermore, it is unclear whether or not this utility loss was due to other factors such as general health utility decline for an old population, as the study was for a single cohort. Dolders and colleagues 101 employed several preference-based instruments (see Table 14) which provide relevant utility estimates but it is unclear whether the study could reliably detect changes in utilities since no statistical tests of differences in relation to first-and second-eye surgery were reported. This may reflect that the aim of the study was to compare two different types of IOL, not to compare first-and second-eye surgery.…”

“…40,86,90,91,94,[101][102][103][104][105][106] The included studies were diverse in terms of their aims, comparisons made, study designs, patient characteristics and locations. The full data extraction forms for all included studies are provided (see Appendix 9).…”

Cost and reimbursement of cataract surgery in Europe: a cross-country comparison

“…Several studies have investigated the economic impact of cataract surgery worldwide (Baltussen et al, 2004;Lansingh et al, 2007;Dolders et al, 2004;Busbee et al, 2002;Busbee et al, 2003;Kobelt et al, 2002;Rasanen et al, 2006;Steinberg et al, 1993;Lundstrom et al, 2000). The majority agree on the favourable cost-effectiveness profile of cataract surgery.…”