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Jenny Qin Hu, Reith Sarkar, James Murphy, Natalie A. Afshari; Cost-effectiveness of multifocal intraocular lenses compared to monofocal intraocular lenses in cataract surgery. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2204.
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While multifocal intraocular lenses (IOLs) are more costly and are associated with a higher rate of glare and haloes compared to their monofocal counterparts, they can decrease spectacle dependence. This study analyzes the cost-effectiveness of multifocal IOLs compared to monofocal IOLs.
In our Markov model, patients received either multifocal or monofocal IOLs during cataract surgery. Patients could then experience spectacle dependence, haloes, and/or glare. Model inputs were sourced from published data. The incremental cost-effectiveness ratio (ICER) was calculated as extra cost in dollars per 1 quality-adjusted life year (QALY) gained. Multifocal IOLs will be considered cost-effective if the ICER is below a willingness-to-pay (WTP) threshold of $50000/QALY. One-way sensitivity analyses were utilized to evaluate for model sensitivity to cost of multifocal IOLs, spectacle dependence, and other model inputs.
Our base-case scenario resulted in a total lifetime QALY of 17.86 and 17.73 for the multifocal and monofocal IOLs respectively. Multifocal IOLs had an ICER of $34000/QALY compared to monofocal IOLs. The model was sensitive to cost of multifocal IOLs, rate of spectacle dependence, rate of haloes and glare, and disutility caused by glasses. Our base-case model assumed that the incremental cost of multifocal IOLs was $4829; if the incremental cost were to be increased to $7000, they would then be considered not cost-effective. Based on prior published data, we assumed a spectacle dependence rate of 24.3% and rate of haloes and glare as near 50%, though if the rates were 45.5% and 65% respectively, multifocal IOLs would be considered not cost-effective. Additionally, this model assumed that the disutility of wearing glasses was -0.022, but if this value were -0.015, multifocal IOLs would not be considered cost-effective.
Over the years, multifocal IOLs have improved in design, which has resulted in decreased rates of spectacle dependence. For patients who have a greater desire to be spectacle free, multifocal IOLs may be considered a cost-effective strategy compared to monofocal IOLs. However, more studies are needed to further evaluate the cost-effectiveness of multifocal IOLs.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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