Modelling lifetime cost consequences of toric compared with standard IOLs in cataract surgery of astigmatic patients in four European countries

Abstract

Objective: To compare the lifetime costs of freeing astigmatic patients from spectacles after bilateral cataract surgery implanting toric intraocular lenses (IOLs: i.e., Acrysof Toric) versus monofocal IOLs, in France, Italy, Germany and Spain.

Methods: A Markov model followed patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles and the types of spectacles prescribed for those requiring them were obtained from clinical trials and national surveys. The economic perspective was societal. Mortality rates were incorporated into the model. Discount rates were applied. A sensitivity analysis was performed on non-discounted costs.

Results: Fewer patients with toric IOLs needed spectacles for distance vision than patients with monofocal IOLs. With monofocal IOLs more than 66% of patients needed complex spectacles compared to less than 25% implanted with toric IOLs. In France and Italy, toric IOLs reduced overall costs relative to otherwise high spectacle costs after cataract surgery. Savings were €897.0 (France), €822.5 (Germany), €895.8 (Italy) and €391.6 (Spain), without discounting. On applying a 3% discount rate the costs became €691.7, €646.4, €693.9 and €308.2, respectively.

Conclusions: Bilateral toric IOL implants in astigmatic patients decreased spectacle dependence for distance vision and the need for complex spectacles. The economic consequences for patients depended on the national spectacle costs usually incurred after cataract surgery.

Key words::

• astigmatism
• cataract surgery
• cost minimisation
• economics
• intraocular lens
• spectacle freedom

Acknowledgement

Declaration of interest: This analysis was supported by a grant from Alcon France SA, Rueil-Malmaison, France. The analysis was performed by Cemka Eval, Bourg-la-Reine, France. Dr Gilles Berdeaux is employed by Alcon France. The authors would like to thank Robert Pigache MD, FFPM for his help with reviewing the English text.

Notes

* Acrysof Toric is a registered trade name of Alcon Laboratories Inc, Fort Worth, TX, USA.