Cost-Utility Analysis of Toric and Monofocal Intraocular Lenses in Cataract Surgery of Astigmatic Patients in the Czech Republic

OBJECTIVES: To evaluate the cost-utility of toric versus monofocal intraocular lens(es) (IOL(s)) implantation during cataract surgery of corneal astigmatism in the Czech Republic.

METHODS: A lifetime Markov cohort model with one-month cycle length was developed to project outcomes (Quality-Adjusted Life-Years, QALYs; spectacles consumption) and costs of astigmatic patients undergoing un-/bilateral cataract surgery from healthcare payers' ± patients‘ perspective.

Model health states are defined by the need for spectacles for sharp vision after cataract surgery, the occurrence of (post)operative complication, and death.

Probability of spectacle (in)dependence, complications and corresponding utilities were derived from the literature, while spectacles replacement and mortality were derived from the local data.

Costs on cataract surgery including lens(es) implantation, management of complications including IOL‘ repositioning, spectacles and its maintanance and associated opthamologic care were based on KOLs’ statements and reimbursement lists.

Costs and outcomes were discounted by 3%.

Deterministic sensitivity analysis (DSA) were conducted.

RESULTS: Astigmatic patients need up to 2,7 fewer spectacles after cataract surgery implanting toric IOL(s) compared to monofocal IOL(s) over their remaining lifetime.

Uni-/bilateral toric IOL(s) implantation provides an additional 0,009/0,113 QALYs compared to monofocal IOL(s) implantation regardless of the perspective used, mainly for spectacle independence increasing patients' quality of life.

Bilateral implantation of toric IOLs compared to monofocal IOLs results in total incremental cost savings (€165/€142), and thus represents the dominant strategy regardless of the perspective.

Unilateral implantation of the compared lenses yields an incremental cost-effectiveness ratio of €1,977/QALY gained from the healthcare payer's perspective and €31,111/QALY gained from both perspectives combined, with additional costs of €19 and €294, respectively.

DSA confirmed the robustness of the results.

CONCLUSIONS: Toric lens(es) implantation is a cost-effective/dominant strategy for cataract surgery in astigmatic patients, protecting patients from spectacle dependence.

Patient’s investment into uni-/bilateral toric IOL(s) implantation is partially/completely compensated by saving on spectacles costs.