Cost-Effectiveness Analysis of Extended Depth of Focus Compared to Trifocal Intraocular Lens in Cataract Surgery

To evaluate the incremental cost-effectiveness of extended depth of focus (EDOF) compared with trifocal intraocular lenses (IOLs) among patients undergoing bilateral cataract surgery who elect for presbyopia-correcting IOL implantation.

Cost-effectiveness analysis using a state-transition (Markov) model.

Hypothetical cohort of 65-year-old patients undergoing bilateral cataract surgery with presbyopia-correcting IOLs.

A lifetime Markov model simulated postoperative health states reflecting spectacle independence, visual disturbances, and mortality. The analysis was framed as a conditional comparison within a presbyopia-correcting IOL population. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER) and net monetary benefit (NMB). A willingness-to-pay (WTP) threshold of $100,000 per quality-adjusted life year (QALY) was applied. One-way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty.

EDOF IOLs resulted in an incremental gain of 0.02 QALYs at an additional cost of $106, yielding an ICER of $6,515 per QALY. The incremental net monetary benefit differed by $1,534 at a WTP threshold of $100,000 per QALY, reflecting minimal economic separation between strategies. One-way sensitivity analyses demonstrated that modest changes in spectacle dependence and visual disturbance resolution could reverse economic preference, indicating proximity to economic neutrality. In probabilistic sensitivity analysis, EDOF IOLs were cost-effective in 56.7% of 10,000 simulations at a WTP threshold of $100,000 per QALY, demonstrating persistent decision uncertainty.

EDOF and trifocal IOLs provide comparable economic value within a presbyopia-correcting IOL population. Given the small incremental differences and persistent uncertainty, lens selection should emphasize individualized, preference-sensitive decision-making rather than population-level economic preference.