Background
Methods
-
A patient freed from spectacles by an MIOL would remain spectacle free for life (MIOLs are implanted for decades of use)
-
The spectacle type prescribed after a monofocal IOL implant was assumed, conservatively, to be similar to that after an MIOL (whereas monofocal spectacles are more frequently provided after MIOLs)
-
Outside the near vision benefit, the risk-benefit ratio with MIOL surgery was made similar to that for monofocal IOLs
-
Patients given excimer laser surgery following MIOL implantation were excluded, as stipulated in the protocol that established the ReSTOR® spectacle independence rate
-
Age was associated with death only, and not with the cost of spectacles.
Efficacy and resource utilisation
Costing
Item | France | Germany | Italy | Spain | ||||
---|---|---|---|---|---|---|---|---|
Society | NHS | Society | NHS | Society | NHS | Society | NHS | |
Cataract surge'ry | ||||||||
1,145.9 | 1,145.9 | 1,250 | 1,250 | 1,106 | 1,106 | 1,050 | 1,050 | |
• ReSTOR® premium1
| 500 | 0 | 500 | 0 | 500 | 0 | 500 | 0 |
• Monofocal IOLs | In DRG | In DRG | In DRG | In DRG | In DRG | In DRG | In DRG | In DRG |
• Other multifocal IOLs2
| [0–500] | 0 | [0–500] | 0 | [0–500] | 0 | [0–500] | 0 |
578.9 | 19.71 | 387.6 | 0 | 310.5 | 0 | 230.2 | 0 | |
Unit cost of cleaning | 3 | 3 | 3 | 3 | ||||
• ophthalmologist | 25 | 16.50 | 57.78 | 23.75 | 100 | 12.91 | 60 | 60 |
• optometrist | - | - | 0 | 0 | 0 | 0 | 40 | 0 |
• visit/implant | 0.39 | - | 0.27 | - | 0.31 | - | 0.46 | - |
• optic centre | 0.31 | - | 0.23 | - | 0.31 | - | 0.45 | - |
Cost of work/hour [47] | 24.7 | - | 26.22 | - | 21.39 | - | 14.75 | - |
Results
Item | France | Germany | Italy | Spain | ||||
---|---|---|---|---|---|---|---|---|
ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | |
Number of spectacles | 1.34 | 6.05 | 1.44 | 6.49 | 1.61 | 7.27 | 1.45 | 6.52 |
Number of units purchased to clean spectacles | 7.5 | 33.9 | 4.55 | 20.46 | 7.02 | 31.59 | 2.97 | 13.34 |
Visit to ophthalmologist to correct visual acuity | 1.34 | 6.05 | 1.28 | 5.77 | 1.34 | 6.03 | 0.94 | 4.24 |
Visit to optometrist to correct visual acuity | - | - | - | - | 0.27 | 1.24 | 0.5 | 2.3 |
Transportation ophthalmologist (km) | 195 | 468 | 82 | 202 | 182 | 466 | 150 | 370 |
Transportation optic centre (km) | 127 | 573 | 87 | 390 | 180 | 808 | 157 | 705 |
Time spent to care for visual acuity (h) | 44.5 | 57.0 | 43.9 | 53.9 | 45.2 | 60.1 | 43.6 | 52.9 |
Item | France | Germany | Italy | Spain | ||||
---|---|---|---|---|---|---|---|---|
ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | |
Surgery including the IOL | 3,292 | 2,292 | 3,500 | 2,500 | 3,212 | 2,212 | 3,100 | 2,100 |
Spectacles | 615 | 2,766 | 447 | 2,009 | 394 | 1,772 | 334 | 1,501 |
Clean spectacles | 17.5 | 78.5 | 11 | 48 | 16 | 73 | 9 | 40 |
Visit to correct visual acuity | 27 | 119 | 59 | 267 | 105 | 474 | 77 | 346 |
Transportation | 100 | 292 | 36 | 117 | 94 | 314 | 140 | 487 |
Total without time spent
|
4,051
|
5,548
|
4,052
|
4,941
|
3,821
|
4,844
|
3,551
|
3,989
|
Time spent | 1,081 | 1,324 | 1,134 | 1,344 | 947 | 1,197 | 635 | 744 |
Total including time spent
|
5,132
|
6,872
|
5,186
|
6,285
|
4,769
|
6,041
|
4,186
|
4,733
|
Difference
|
-1,741
|
Ref
|
-1,099
|
Ref
|
-1,272
|
Ref
|
-547
|
Ref
|
France | Germany | Italy | Spain | |||||
---|---|---|---|---|---|---|---|---|
Item | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal | ReSTOR®
| Monofocal |
Surgery including the IOL |
2,292
|
2,292
|
2,500
|
2,500
|
2,212
|
2,212
|
2,100
|
2,100
|
Spectacles | 21 | 94 | 0 | 0 | 0 | 0 | 0 | 0 |
Visit to correct visual acuity | 17 | 79 | 24 | 110 | 14 | 61 | 50 | 224 |
Total
|
2,330
|
2,465
|
2,524
|
2,610
|
2,226
|
2,273
|
2,150
|
2,324
|
Difference
|
-135
|
Ref
|
-85
|
Ref
|
-48
|
Ref
|
-174
|
Ref
|
Spectacle dependence rates | Discount Rate = 0% | Discount Rate = 3% | Discount Rate = 5% | |||||||
---|---|---|---|---|---|---|---|---|---|---|
€0 | €250 | €500 | €0 | €250 | €500 | €0 | €250 | €500 | ||
France
| ||||||||||
% of spectacles after MIOL
|
20%
| -3,164 | -2,664 | -2,164 | -2,497 | -1,997 | -1,497 | -2,182 | -1,682 | -1,182 |
40%
| -2,260 | -1,760 | -1,260 | -1,784 | -1,284 | -784 | -1559 | -1,059 | -559 | |
60%
| -1,356 | -856 | -356 | -1,070 | -570 | -70 | -935 | -435 |
65
| |
80%
| -452 |
48
|
548
| -357 |
143
|
643
| -312 |
188
|
688
| |
Germany
| ||||||||||
% of spectacles after MIOL
|
20%
| -2,365 | -1,865 | -1,365 | -1,888 | -1,388 | -888 | -1,658 | -1,158 | -658 |
40%
| -1,689 | -1,189 | -689 | -1,349 | -849 | -349 | -1,184 | -684 | -184 | |
60%
| -1,014 | -514 | -14 | -809 | -309 |
191
| -710 | -210 |
290
| |
80%
| -338 |
162
|
662
| -270 |
230
|
730
| -237 |
263
|
763
| |
Italy
| ||||||||||
% of spectacles after MIOL
|
20%
| -2,580 | -2,080 | -1,580 | -2,023 | -1,523 | -1,023 | -1,759 | -1,259 | -759 |
40%
| -1,843 | -1,343 | -843 | -1,445 | -945 | -445 | -1,256 | -756 | -256 | |
60%
| -1,106 | -606 | -106 | -867 | -367 |
133
| -754 | -254 |
246
| |
80%
| -369 |
131
|
631
| -289 |
211
|
711
| -251 |
249
|
749
| |
Spain
| ||||||||||
% of spectacles after MIOL
|
20%
| -1,815 | -1,315 | -815 | -1,438 | -938 | -438 | -1,258 | -758 | -258 |
40%
| -1,296 | -796 | -296 | -1,027 | -527 | -27 | -898 | -398 |
102
| |
60%
| -778 | -278 |
222
| -616 | -116 |
384
| -539 | -39 |
461
| |
80%
| -259 |
241
|
741
| -205 |
295
|
795
| -180 |
320
|
820
|
Spectacle dependence rates after MIOLs | Discount Rate | ||
---|---|---|---|
0% | 3% | 5% | |
France
| |||
20%
| -170 | -135 | -118 |
40%
| -122 | -96 | -84 |
60%
| -73 | -58 | -50 |
80%
| -24 | -19 | -17 |
Germany
| |||
20%
| -209 | -166 | -145 |
40%
| -149 | -119 | -104 |
60%
| -89 | -71 | -62 |
80%
| -30 | -24 | -21 |
Italy
| |||
20%
| -61 | -48 | -41 |
40%
| -43 | -34 | -30 |
60%
| -26 | -20 | -18 |
80%
| -9 | -7 | -6 |
Spain
| |||
20%
| -219 | -174 | -152 |
40%
| -156 | -124 | -109 |
60%
| -94 | -75 | -65 |
80%
| -31 | -25 | -22 |