Clinical Study
Eye advance online publication 3 July 2009; doi: 10.1038/eye.2009.151
Lifetime costs and effectiveness of ReSTOR compared with a monofocal IOL and Array-SA40 in the Netherlands
Presentation: ISPOR, Athens, November 2008
N E De Vries1, C Laurendeau2, A Lafuma2, G Berdeaux3,4 and R M M A Nuijts1
- 1Department of Ophthalmology, University Hospital Maastricht, Maastricht, The Netherlands
- 2Cemka, Bourg-la-Reine, France
- 3Health Economic, Europe, Alcon France, Rueil-Malmaison, France
- 4Conservatoire National des Arts et Métiers, Chaire Economie et gestion des services de santé, Paris, France
Correspondence: G Berdeaux, Health Economics, Alcon France, 4, Rue Henri Sainte-Claire Deville, Bat B, Rueil-Malmaison, Hauts-de-Seine F-92563, France. Tel: +33 1 47 10 48 60; Fax: +33 1 47 10 27 70. E-mail: gilles.berdeaux@alconlabs.com
Received 23 February 2009; Revised 18 May 2009; Accepted 18 May 2009; Published online 3 July 2009.
Abstract
Purpose
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.
Setting
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 
3969, monofocal IOLs 4123, and Array-SA40 5326. Corresponding costs for the NHS were 2415, 2555, and 2556, 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 315 for society and 140 for the NHS.
Keywords:
cataract surgery, spectacle freedom, cost minimization, multifocal intraocular lens
