Cost-effectiveness analysis of PMMA, silicone, or acrylic intra-ocular lenses in cataract surgery in four European countries.
OBJECTIVE
To compare the cost-effectiveness of different intra-ocular lens (IOL) materials (Hydrophobic acrylic, Polymethylmethacrylate (PMMA), Hydrophilic acrylic and Silicone) implanted after cataract surgery with reference to Nd:YAG laser capsulotomy and Nd:YAG-related complications in four European countries (France, Italy, Germany and Spain).


METHODS
A retrospective review of 1,525 patients (eyes), aged 50 to 80 years, operated with phacoemulsification for cataract in 1996 or 1997 in 16 surgical centres (4 per country).


METHODS
The study was conducted using a cost-effectiveness approach. Medical charts were reviewed to collect retrospective information during the 3-year period following cataract surgery in order to identify patients who underwent Nd:YAG laser capsulotomy post-operatively. Clinical data were combined with unit costs assessed by experts for Nd:YAG laser capsulotomy and their complications. A cost-effectiveness ratio (cost per patient without Nd:YAG laser capsulotomy intervention) was estimated in relation to each IOL material used in each of the four European countries.


RESULTS
Hydrophobic acrylic, specifically Acrysof, was the most cost-effective IOL material in all the countries except Germany where it was second. PMMA had the best ratio in Germany, was second in Spain and only third in Italy and France. Silicone was second in France and ranked third in the other countries, while hydrophilic acrylic had the worst ratio overall in all countries.


CONCLUSIONS
Cost-effectiveness ratios of hydrophobic acrylic (Acrysof) were better than those of other types of IOL materials used in most of the countries. Sensitivity analyses were performed to vary the base case analysis to demonstrate the economic importance of the assumptions. In all cases, hydrophobic acrylic IOL material was shown to be a highly cost-effective option.
Smith
Andrew F
AF
Health Economics Unit, Alcon Laboratories Ltd., Hemel Hempstead, England, UK. andrew.f.smith@alconlabs.com
Lafuma
Antoine
A
Berdeaux
Gilles
G
Berto
Patrizia
P
Brueggenjuergen
Bernd
B
Magaz
Sol
S
Auffarth
Gerd K
GK
Brezin
Antoine
A
Caporossi
Aldo
A
Mendicute
Javier
J
D000180:Acrylic Resins / Q000191:economics*; D000368:Aged; D002386:Cataract / Q000628:therapy; D002387:Cataract Extraction / Q000191:economics*; D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006801:Humans; D053685:Laser Therapy; D007903:Lens Capsule, Crystalline / Q000601:surgery; D019654:Lens Implantation, Intraocular / Q000191:economics; D007910:Lenses, Intraocular / Q000191:economics*; D008297:Male; D008875:Middle Aged; D019904:Polymethyl Methacrylate / Q000191:economics*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012826:Silicone Elastomers / Q000191:economics*
D000180:Acrylic Resins; D012826:Silicone Elastomers; D019904:Polymethyl Methacrylate