OBJECTIVES: The objective of this study was to determine the relative cost-effectiveness of three multifocal intraocular lenses (IOLs) commonly implanted in cataract patients. METHODS: A cost-effectiveness analysis was performed to determine the cost-effectiveness ratios for the following three multifocal intraocular lenses available in the U.S. healthcare market: an apodized diffractive multifocal (ADM) IOL, a zonal refractive multifocal (ZRM) IOL and an accommodating posterior chamber (APC) IOL. The measure of effectiveness used was vision adjusted life years (VALYs). VALYs are the product of the uncorrected near visual acuity (UCNVA) provided by the IOLs and the average life expectancy of the cataract patients. UCNVA, expressed in decimal notation, and cost estimates were taken from the medical literature. UCNVA was chosen as the measure of effect because it is generally accepted that uncorrected distance visual acuity outcomes are similar between the 3 alternative IOLs. The economic perspective was that cataract patients enrolled in the United States Medicare program. Only the direct incremental costs of the multifocal IOLs were considered in the analysis. The time span of the analysis was 14.2 years based on cataract patients' average life expectancy (ALE). No cost discounting was performed because all incremental costs considered accrue in year one. RESULTS: The average cost to patients for bilateral multifocal IOL implantation was estimated at $4000. The average UCNVAs, expressed in Snellen decimal notation, for the ADM, ZRM and APC IOLs were 0.80, 0.57 and 0.7, respectively. The VALY products of UCNVA and ALE for the ADM, ZRM and APC IOLs were 11.36, 9.94 and 8.09 respectively. The resultant VALY cost-effectiveness ratios for the ADM, ZRM and APC IOLs were $352.11, $494.19 and $402.41, respectively. CONCLUSION: Given the incremental cost associated with multifocal IOLs the ADM IOL provides cataract patients with the best value for their money.