Lifetime costs and effectiveness of ReSTOR compared with a monofocal IOL and Array-SA40 in the Netherlands.
OBJECTIVE
To estimate the lifetime cost consequences for society and the National Health Service (NHS) of bilateral monofocal (SI40NB) or multifocal (ReSTOR or Array-SA40) intraocular lense (IOL) implantation after cataract surgery.


METHODS
Public hospital in the Netherlands.


METHODS
A Markov model simulated three cohorts of patients followed 69 until 100 years of age, or death. Spectacle independence rates for each IOL were adjusted to the results of a randomized clinical trial that compared monofocal and multifocal Array-SA40 IOL implants, together with a prospective cohort of patients implanted with ReSTOR. Adjustment was performed using the propensity score method in a multivariate analysis. Resource consumption was estimated from a dedicated Dutch survey. Dutch unit costs were applied to spectacles, cataract surgery, IOLs, visits to ophthalmologists, optometrists, transport, and spectacle cleaning materials. Cost discounted at 4% and undiscounted economic results were calculated.


RESULTS
Spectacle independence rates were 86.0% for ReSTOR, 8.7% for monofocal IOLs, and 8.5% for Array-SA40. Patients lived without needing spectacles for 12.9 years after ReSTOR, for 1.4 years after monofocal IOLs, and 1.3 years after Array-SA40. ReSTOR patients bought 6.4 fewer pairs of spectacles than monofocal patients. Lifetime discounted cost consequences for the society were ReSTOR euro3969, monofocal IOLs euro4123, and Array-SA40 euro5326. Corresponding costs for the NHS were euro2415, euro2555, and euro2556, respectively.


CONCLUSIONS
ReSTOR IOLs provided higher levels of spectacle independence than monofocal SI40NB or multifocal Array-SA40 IOLs resulting in savings, compared to a monofocal, over the period modelled of euro315 for society and euro140 for the NHS.
De Vries
N E
NE
Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands.
Laurendeau
C
C
Lafuma
A
A
Berdeaux
G
G
Nuijts
R M M A
RM
D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000191:economics*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005139:Eyeglasses / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000191:economics* / Q000379:methods*; D007910:Lenses, Intraocular / Q000191:economics*; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D009426:Netherlands; D009885:Ophthalmology / Q000191:economics; D009907:Optometry / Q000191:economics