Economic Value of Enhanced Monofocal Intraocular Lenses for Cataract Surgery in Italy

Cataract is a prevalent health condition, primarily caused by aging, affecting approximately 95 million individuals worldwide. The only effective treatment currently involves surgically removing and replacing the crystalline lens with an artificial intraocular lens (IOL). Various IOLs are available, each with distinct characteristics, costs, and outcomes. This study aimed to assess the value of an enhanced monofocal IOL for cataract surgery, which has been shown to improve intermediate vision and reduce the need for spectacles during intermediate tasks, compared to a conventional monofocal IOL (standard of care), through a cost-utility analysis from both the National Healthcare Service (NHS) and societal perspectives in Italy.

A cost-utility model was developed incorporating both healthcare and nonhealthcare costs, as well as productivity losses, using data from a socio-economic questionnaire administered at three clinical centers in Italy. The questionnaire included the EuroQol 5D-5L to assess quality of life. National Healthcare Service costs were based on reimbursement tariffs.

Over a 10-year horizon, estimated costs were 15,723 € (16,643 USD) for the standard IOL group and 11,190 € (11,845 USD) for the enhanced monofocal IOL group from the societal perspective. Since no significant differences in patients' quality of life were observed between the two groups, the innovative IOL may be considered a cost-saving option compared to standard monofocal IOL. From the NHS perspective, only the intervention for lens implantation was considered, resulting in costs of 940 € (994.99 USD) and 900 € (952.65 USD) for enhanced monofocal IOL and standard IOL, respectively. In this perspective, enhanced monofocal IOL was dominated (more costly with the same QALYs) by standard IOL.

This study fills a literature gap by evaluating the cost-utility of enhanced monofocal IOLs for cataract surgery compared to standard IOLs. While enhanced monofocal IOL is dominated from the NHS perspective due to slightly higher direct healthcare costs, it is cost-saving from a societal perspective by reducing the overall economic burden with comparable patients' quality of life. The broader benefits, including reduced reliance on corrective measures, visits and exams, formal and informal assistance, emphasize its societal value. This highlights the need for a holistic healthcare approach that balances long-term societal savings with short-term healthcare costs.