Cost-effectiveness analysis of toric vs monofocal intraocular lenses in cataract patients with bilateral corneal astigmatism

Session Details

Session Title: Pseudophakic IOLs: Toric II

Session Date/Time: Sunday 11/09/2016 | 16:00-18:00

Paper Time: 16:50

Venue: Auditorium C6

First Author: : R.Simons THE NETHERLANDS

Co Author(s): :    N. Visser   F. van den Biggelaar   R. Nuijts   C. Webers   N. Bauer   C. Dirksen     

Abstract Details

Purpose:

To evaluate the cost-effectiveness of toric versus monofocal intraocular lenses (IOLs) in cataract patients with bilaterally ≥1,25 dioptres of corneal astigmatism.

Setting:

University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands, and Zuyderland Medical Centre, Heerlen, The Netherlands.

Methods:

This cost-effectiveness analysis was conducted alongside a multicentre randomized controlled trial that evaluated spectacle independence and quality of vision after bilateral phacoemulsification with toric or monofocal IOL implantation. Quality-adjusted life years (QALYs) were measured with the Health Utilities Index Mark 3 questionnaire. Data on costs and volumes were collected through patient records and questionnaires, hospital registries, and standard prices, with 2012 as the base year. The primary outcome was the Incremental Cost-Effectiveness Ratio (ICER) within the time horizon of the trial (i.e. six months) from a societal perspective. In a secondary analysis, costs and effects were extrapolated to lifetime.

Results:

Average QALYs were lower in the toric IOL group (n=33) than the monofocal IOL group (n=44), 0.30 and 0.31 respectively. Average costs were higher in the toric IOL group (€3,202 vs. €2,795). Therefore, treatment with toric IOLs was dominated by treatment with monofocal IOLs. Adjusting for imbalance in baseline utility improved average QALYs in the toric IOL group to 0.32, leading to an ICER of €43,027/QALY. In the secondary analysis, average discounted QALYs were 7.03 and 7.38 in the toric and monofocal IOL group respectively. Average discounted costs were €3,456 and €3,277, resulting in domination of treatment with monofocal IOLs.

Conclusions:

Toric IOLs are unlikely to be cost-effective as compared to monofocal IOLs in patients with bilateral corneal astigmatism undergoing cataract surgery. In patients with a preference for toric IOLs, it is advised to cover the additional costs by patient co-payment.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented