June 2023
Volume 64, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2023
Cost-effectiveness analysis of Light Adjustable Lens in cataract surgery using a Markov model
Author Affiliations & Notes
  • Taiki W Nishihara
    University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, United States
  • Jenny Q Hu
    University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, United States
  • Rhiannon D Buccholz
    University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, United States
  • James D. Murphy
    University of California at San Diego Department of Radiation Medicine and Applied Sciences, La Jolla, California, United States
  • Natalie A Afshari
    University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, United States
  • Footnotes
    Commercial Relationships   Taiki Nishihara None; Jenny Hu None; Rhiannon Buccholz None; James Murphy None; Natalie Afshari None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2023, Vol.64, 1215. doi:
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    • Get Citation

      Taiki W Nishihara, Jenny Q Hu, Rhiannon D Buccholz, James D. Murphy, Natalie A Afshari; Cost-effectiveness analysis of Light Adjustable Lens in cataract surgery using a Markov model. Invest. Ophthalmol. Vis. Sci. 2023;64(8):1215.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To analyze the cost-effectiveness of the Light Adjustable Lens (LAL) with conventional monofocal intraocular lenses (IOLs) in individuals undergoing cataract surgery in both eyes.

Methods : A Markov model was developed to simulate the outcomes of cataract surgery with LAL or monofocal IOLs. The associated costs, utility values, and transition probabilities were obtained for this model through published clinical trial results whenever possible, and when clinical trials were not available, model inputs were identified from the literature. The cost-effectiveness of the two IOLs was assessed using an incremental cost-effectiveness ratio calculated as the ratio of incremental costs to incremental effectiveness in terms of quality-adjusted life-years (QALY). The model was created using TreeAge Pro software, with a cycle length of 1 year and an annual discount rate of 3%. The base case analysis was run with a patient starting age of 65 and allowed to continue until patient death based on mortality rates from social security. For this study, the impact of parameter uncertainties on the overall cost-effectiveness was analyzed using one-way sensitivity analyses and probabilistic sensitivity analysis with 100,000 iterations of parameter distributions. All analyses were reported from the societal perspective, considering total healthcare and non-healthcare costs of the interventions.

Results : The study found that individuals who opt for cataract surgery with LAL gain an incremental effectiveness of 0.84 QALYs at an incremental cost of $8,431 in comparison to monofocal IOL. The resulting incremental cost-effectiveness ratio of $10,072/QALY was well below the established willingness-to-pay (WTP) threshold of $50,000/QALY considered to be cost-effective. The model was most sensitive to patient age and the visual acuity-based utility scores for LAL and monofocal IOL. The probabilistic sensitivity analysis reported that cataract surgeries in patients starting at age 65 were cost-effective in 94 percent of the simulations at a WTP of $50,000/QALY.

Conclusions : The study suggests that cataract surgery with LAL is highly cost-effective in comparison to surgery with conventional monofocal IOL. Future studies are needed to compare LAL to other premium lenses which can also provide excellent visual outcomes at a higher cost.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

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