Qianqian Lan1,2, Yiyun Liu1, Fan Xu2, Min Li2, Yaxin Li1, Tingting Yang1, Tong Sun1, Gang Yao2, Baikai Ma1, Liyuan Tao3, Xin Xiao2, Xing Lin Feng4, Siming Zeng5, Hong Qi6. 1. Department of Ophthalmology, Peking University Third Hospital and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. 2. Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region, No.6, Taoyuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China. 3. Research Center of Clinical Epidemiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. 4. School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China. fxl@bjmu.edu.cn. 5. Institute of Ophthalmic Diseases, Guangxi Academy of Medical Sciences, Guangxi Health Commission Key Laboratory of Ophthalmology and Related Systemic Diseases Artificial Intelligence Screening Technology, Department of Ophthalmology, the People's Hospital of Guangxi Zhuang Autonomous Region, No.6, Taoyuan Road, Nanning, 530021, Guangxi Zhuang Autonomous Region, China. gxeye@126.com. 6. Department of Ophthalmology, Peking University Third Hospital and Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China. doctorqihong@163.com.
Abstract
INTRODUCTION: The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. METHODS: The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter "rate", a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1 logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. RESULTS: In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8-102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95% CI 34.57-56.50)], followed by the blended [$59.10/1% rate (95% CI 31.72-86.48)], diffractive bifocal [$69.06/1% rate (95% CI 30.89-107.21)], EDOF [$72.85/1% rate (95% CI 52.02-93.70)], trifocal [$93.01/1% rate (95% CI 83.23-102.79)], monovision [$136.83/1% rate (95% CI - 55.40 to 329.14)], and monofocal [$264.45/1% rate (95% CI - 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China's annual disposable income per capita in 2021 per 10% incremental rates. CONCLUSIONS: Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04265846).
INTRODUCTION: The aim of this study was to explore a method to rank the cost-effectiveness of presbyopia correction in diverse strategies of bilateral cataract surgery to provide references for healthcare policymakers in rationalizing resource utilization and surgeons in customizing patient management. METHODS: The cost-effectiveness analysis based on a prospective single-blind two-center clinical trial included seven strategies in bilateral cataract surgery: monofocal, monovision, diffractive bifocal, blended, refractive bifocal, trifocal, and extended depth of focus (EDOF) strategies. The effectiveness according to the objective spectacle independence rate (hereafter "rate", a novel indicator defined as the proportion of patients with binocular uncorrected distance, intermediate and near visual acuity all better than 0.1 logMAR, logarithm of the minimum angle of resolution), costs, average cost-effectiveness ratios (ACERs, $/1% rate), and incremental cost-effectiveness ratios (ICERs, $/1% incremental rate) were estimated. RESULTS: In 194 participants (388 eyes), the trifocal strategy achieved the highest rate [93.10% (95% confidence interval (CI) 83.8-102.35%)]. The refractive bifocal strategy had the minimum ACER [$45.54/1% rate (95% CI 34.57-56.50)], followed by the blended [$59.10/1% rate (95% CI 31.72-86.48)], diffractive bifocal [$69.06/1% rate (95% CI 30.89-107.21)], EDOF [$72.85/1% rate (95% CI 52.02-93.70)], trifocal [$93.01/1% rate (95% CI 83.23-102.79)], monovision [$136.83/1% rate (95% CI - 55.40 to 329.14)], and monofocal [$264.45/1% rate (95% CI - 97.45 to 626.55)] strategies. Compared with the refractive bifocal strategy, the probabilities that the trifocal strategy (ICER $289.74/1% incremental rate) is very cost-effective and cost-effective were 81.7% and 93.2%, respectively, at the wiliness-to-pay threshold of one and three times China's annual disposable income per capita in 2021 per 10% incremental rates. CONCLUSIONS: Cost-effectiveness analysis with ACER and ICER according to objective spectacle independence rate is a helpful tool to identify highly cost-effective presbyopia-correcting strategies in cataract surgery for clinical and policy decisions. TRIAL REGISTRATION: Clinicaltrials.gov (NCT04265846).
Authors: Timothy R Fricke; Nina Tahhan; Serge Resnikoff; Eric Papas; Anthea Burnett; Suit May Ho; Thomas Naduvilath; Kovin S Naidoo Journal: Ophthalmology Date: 2018-05-09 Impact factor: 12.079
Authors: William A Maxwell; Curtis R Waycaster; Anna O D'Souza; Brian L Meissner; Kendra Hileman Journal: J Cataract Refract Surg Date: 2008-11 Impact factor: 3.351