title: Cost-effectiveness comparison between monofocal and multifocal intraocular lens implantation for cataract patients in Taiwan.
abstract: OBJECTIVE
  Our aim was to conduct a cost-effectiveness analysis (CEA) of monofocal and multifocal intraocular lenses (IOLs) for cataract patients in Taiwan.
  
  
  METHODS
  This prospective nonrandomized study was designed to evaluate the effectiveness of monofocal and multifocal IOLs by means of visual performance, visual quality, vision-related quality of life, and spectacle-independence rates. The direct costs were calculated using the payment points of the fee schedule for medical services multiplied by the treatment items. The concept of incremental cost effectiveness ratios was used to evaluate the costs of different types of IOLs in cataract surgery and postoperative outcomes in patients.
  
  
  RESULTS
  A total of 61 patients from the monofocal IOL group (n = 21), multifocal IOL group 1 (n = 22), and multifocal IOL group 2 (n = 18) who completed the study were included in the analysis. No significant differences were observed in mean ages or patient to eye ratio. Significant differences in effectiveness after the implantations of monofocal and multifocal IOLs were observed for spectacle-free rate and monocular contrast sensitivity under glare conditions only. The incremental cost-effectiveness ratios of monofocal versus multifocal IOLs indicated that it cost an additional $57 to $58 (US dollars) to increase each 1% of the spectacle-independence rate.
  
  
  CONCLUSIONS
  This study's results indicated that multifocal IOLs provided better effectiveness on vision-related indicators like the incremental cost effectiveness ratios of postoperative spectacle-independence rate and binocular best-corrected visual acuity measurements at near vision. Our findings suggest that multifocal IOLs can be highly cost effective for patients who prefer to be spectacle free, so it is important to ensure that patients have realistic expectations when making choices between monofocal and multifocal IOLs.
authors.affiliation: Department of Ophthalmology, Taipei City Hospital, Heping Fuyoy Branch, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: jclin54@yahoo.com.tw.
authors.forename: Jen-Chieh
authors.initials: JC
authors.lastname: Lin
authors.affiliation: Graduate Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000191:economics* / Q000628:therapy*; D002387:Cataract Extraction; D003362:Cost-Benefit Analysis; D005139:Eyeglasses; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000191:economics* / Q000379:methods*; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011788:Quality of Life; D013624:Taiwan; D014792:Visual Acuity
keywords: CEA; ICER; IOL; cataract; cost-effectiveness analysis; incremental cost effectiveness ratio; intraocular lens; visual performance