RESUMEN
OBJECTIVES: To evaluate the relationship between social determinants of health and the likelihood of receiving a premium intraocular lens (IOL) at the time of cataract surgery. METHODS: Retrospective chart review of a single-center, academic ophthalmology practice over a one-year period, with a primary outcome measure of placement of either a premium or standard IOL. We used logistic regression to calculate the odds of receiving a premium IOL, stratifying patients based on self-identified race/ethnicity, age, sex, insurance type (private insurance vs. Medicare or Medicaid), estimated household income (based on median household income for zip code), and presence of ocular pathology. RESULTS: Compared with self-identified White patients, Black patients were least likely to receive premium IOLs (OR=0.220, 95% CI 0.137-0.340, P <0.001), followed by Hispanic patients (OR=0.308, 95% CI 0.104-0.730) and Asian patients (OR=0.479, 95% CI 0.302-0.734). Patients with Medicare or Medicaid insurance were also less likely to receive premium IOLs (OR 0.522, 95% CI 0.336-0.784). CONCLUSIONS: White patients in our practice were more likely to receive premium IOLs than non-White patients, even when controlling for age, sex, insurance type, estimated median household income, and presence of ocular comorbidities. The underlying reason for this disparity should be explored further.
Asunto(s)
Lentes Intraoculares , Humanos , Femenino , Masculino , Estudios Retrospectivos , Anciano , Lentes Intraoculares/economía , Estados Unidos , Persona de Mediana Edad , Implantación de Lentes Intraoculares/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Medicare/estadística & datos numéricos , Anciano de 80 o más Años , Extracción de Catarata/estadística & datos numéricos , Extracción de Catarata/economía , Adulto , Grupos Raciales/estadística & datos numéricos , Medicaid/estadística & datos numéricosRESUMEN
PURPOSE: To determine the cost-effectiveness of multifocal intraocular lenses (IOLs) compared to that of monofocal IOLs from a societal and health care sector perspective. DESIGN: Cost-effectiveness analysis. METHODS: A Markov model was constructed that simulated patients who received either multifocal or monofocal IOLs during cataract surgery. Postoperatively, patients could experience spectacle dependence, glare, and haloes. Cost-effectiveness was determined by measuring the incremental cost-effectiveness ratio (ICER) as the incremental cost in dollars per quality-adjusted life year (QALY) gained. Treatments with an ICER below the standard willingness-to-pay (WTP) threshold of $50,000/QALY were considered cost effective. One-way sensitivity analyses and probabilistic sensitivity analyses were used to evaluate model sensitivity to cost, utilities, and other model inputs. RESULTS: Multifocal IOLs were associated with a 0.71 QALY increase at an increased cost of $3,415 compared with monofocal IOLs, leading to an ICER of $4,805/QALY from the societal and health care sector perspectives. The cost-effectiveness model was most sensitive to patient age, probability of spectacle dependence with multifocal IOLs and monofocal IOLs, and the disutility of glasses. Probabilistic sensitivity analysis found multifocal IOLs to be the cost-effective option compared with monofocal IOLs 99.9% of the time at a WTP threshold of $50,000/QALY. CONCLUSIONS: From a societal and health care perspective, multifocal IOLs would be considered a cost-effective strategy compared to monofocal IOLs for patients who desire a higher chance to be spectacle-free. However, more studies need to be conducted to further evaluate the efficacy of multifocal IOLs.
Asunto(s)
Extracción de Catarata/economía , Análisis Costo-Beneficio , Lentes Intraoculares/economía , Lentes Intraoculares Multifocales/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Implantación de Lentes Intraoculares , Masculino , Cadenas de Markov , Persona de Mediana Edad , Aceptación de la Atención de Salud , Años de Vida Ajustados por Calidad de Vida , Encuestas y CuestionariosRESUMEN
BACKGROUND: Cataract surgery with pseudophakic mini-monovision has lower out-of-pocket patient expense than premium multifocal intraocular lenses (IOL). The purpose of this study was to evaluate patient-reported satisfaction and spectacle dependence for key activities of daily living after cataract surgery with pseudophakic mini-monovision. The study also examined statistical relationships between patient demographic variables, visual acuity and satisfaction. METHODS: Prospective cohort study of 56 patients (112 eyes) who underwent bilateral cataract surgery with pseudophakic mini-monovision. Mini-monovision corrects one eye for distance vision and the other eye is focused at near with - 0.75 to - 1.75 D of myopia. All patients with 1 diopter or greater of corneal astigmatism had a monofocal toric IOLs implanted or limbal relaxing incision. The main study outcomes were assessed at the last follow-up appointment and included refraction, visual acuity, patient reported spectacle use, and patient satisfaction. Descriptive statistics, correlation matrixes and Pearson's chi-square tests were examined. RESULTS: Uncorrected visual acuity was significantly better post-operatively. Most patients reported the surgery met their expectations for decreased dependence on spectacles (93%). Most patients report little or no use of spectacles post-operatively for computer use (93%), distance viewing (93%) and general use throughout the day (87%). A small number of patients report spectacle use for reading (9%) and night driving (18%). There were no relationships detected between demographic variables and visual acuity or patient satisfaction. CONCLUSIONS: Aging of the population presents one of the biggest challenges in the health sector, which includes a rising number of individuals with chronic vision impairment and increased demand for accessible treatment strategies. Cataract surgery with pseudophakic mini-monovision results in high patient satisfaction and considerable reduction in spectacle dependence. Pseudophakic mini-monovision technique is a low-cost, valuable option for patients who would like to reduce dependence on spectacles post-operatively and should be considered along with premium multifocal IOLs in options available for patients based on their needs, preferences and clinical indicators. Reducing spectacle dependence with the pseudophakic mini-monovision technique could improve the functionality, independence and quality of life for many patients who are unsuitable or are unable to pay additional fees associated with premium multifocal IOLs.
Asunto(s)
Análisis Costo-Beneficio , Anteojos/estadística & datos numéricos , Lentes Intraoculares , Satisfacción del Paciente , Facoemulsificación , Seudofaquia/fisiopatología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Biometría , Catarata/fisiopatología , Femenino , Humanos , Implantación de Lentes Intraoculares , Lentes Intraoculares/economía , Masculino , Persona de Mediana Edad , Facoemulsificación/economía , Estudios Prospectivos , Calidad de Vida , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.
Asunto(s)
Resinas Acrílicas/economía , Resinas Acrílicas/uso terapéutico , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares/economía , Facoemulsificación/métodos , Anciano , Anciano de 80 o más Años , Opacificación Capsular/etiología , Costos y Análisis de Costo , Estudios de Seguimiento , Humanos , Implantación de Lentes Intraoculares/efectos adversos , Implantación de Lentes Intraoculares/economía , Lentes Intraoculares/efectos adversos , Persona de Mediana Edad , Facoemulsificación/efectos adversos , Facoemulsificación/economía , Complicaciones Posoperatorias , Diseño de Prótesis , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Agudeza VisualRESUMEN
OBJECTIVE: To evaluate the efficiency of long-term cataract surgery using low-cost intraocular lens implantation in community campaigns. METHODS: Fifty-eight randomly selected patients were evaluated four years after phacoemulsification and Ioflex intraocular lens implantation. Causes of low visual acuity related to the intraocular lens were evaluated, and treatment costs were calculated. RESULTS: The mean age of patients was 72±10.2 years. Four years after surgery, 25 eyes (43.0%) had decreased visual acuity related to the intraocular lens: posterior capsule opacification was noted in 24 eyes (41.3%), and intraocular lens opacification was noted in one eye (1.7%). The total cost of the post-surgical complication treatments represented 6.3% of the initial budget of the entire surgical patient group. CONCLUSIONS: The efficiency of cataract surgery with low-cost Ioflex intraocular lens implantation was significantly reduced in a long-term follow-up study because postoperative complications related to intraocular lenses emerged at higher rates than when the gold-standard treatment was used.
Asunto(s)
Humanos , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Resinas Acrílicas/economía , Resinas Acrílicas/uso terapéutico , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares/economía , Facoemulsificación/métodos , Opacificación Capsular/etiología , Costos y Análisis de Costo , Estudios de Seguimiento , Implantación de Lentes Intraoculares/efectos adversos , Implantación de Lentes Intraoculares/economía , Lentes Intraoculares/efectos adversos , Facoemulsificación/efectos adversos , Facoemulsificación/economía , Complicaciones Posoperatorias , Diseño de Prótesis , Reproducibilidad de los Resultados , Factores de Tiempo , Resultado del Tratamiento , Agudeza VisualRESUMEN
No disponible
Asunto(s)
Femenino , Humanos , Masculino , Extracción de Catarata/historia , Extracción de Catarata/métodos , Lentes Intraoculares/efectos adversos , Lentes Intraoculares/historia , Historia Medieval , Extracción de Catarata/clasificación , Extracción de Catarata/instrumentación , Lentes Intraoculares/economía , Lentes Intraoculares/provisión & distribuciónRESUMEN
PURPOSE: To analyze differences in the cost of treatment for infants randomized to primary intraocular lens (IOL) implantation versus optical correction with a contact lens (CL) after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). DESIGN: Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid reimbursement data as well as actual costs of supplies used during the study, adjusted for inflation. PARTICIPANTS: The IATS is a multicenter (n = 12), randomized clinical trial comparing the optical treatment of aphakia with either primary IOL implantation (n = 57) or CL correction (n = 57) in 114 infants with unilateral congenital cataract. INTERVENTION: One hundred fourteen infants underwent unilateral cataract surgery and were either corrected optically by primary IOL implantation at the time of surgery or were corrected with a CL after surgery. MAIN OUTCOME MEASURES: The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 5 years of age. RESULTS: The 5-year treatment cost of an infant with a unilateral congenital cataract corrected optically with an IOL was $27 090 versus $25 331 for a patient treated with a CL after initial cataract surgery. The total cost of supplies was $3204 in the IOL group versus $7728 in the CL group. CONCLUSIONS: Unilateral cataract surgery in infancy coupled with primary IOL implantation is approximately 7% more expensive than aphakia and CL correction. Patient costs are more than double with CL versus IOL treatment.
Asunto(s)
Afaquia Poscatarata/economía , Afaquia Poscatarata/terapia , Extracción de Catarata/economía , Catarata/congénito , Lentes de Contacto/economía , Lentes Intraoculares/economía , Análisis Costo-Beneficio , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Implantación de Lentes Intraoculares , Visita a Consultorio Médico , Oftalmología/economía , Estudios Prospectivos , Estudios Retrospectivos , Agudeza Visual/fisiologíaRESUMEN
IMPORTANCE: The cost difference is evaluated between delayed sequential cataract surgery (DSCS) and immediate sequential cataract surgery (ISCS) in the United States for patients covered by Medicare. OBJECTIVE: To perform a cost-minimization analysis comparing ISCS with DSCS in the United States from the payer, patient, and societal perspectives for the West Tennessee region and nationally. DESIGN, SETTING, AND PARTICIPANTS: A cost-minimization analysis using cataract surgery volume and eligibility estimates, 2012 Medicare reimbursement schedules, and actual or estimated patient cost data for the West Tennessee region and nationally was performed comparing ISCS with DSCS. The West Tennessee model was set in a mixed small city and rural private practice setting and was extrapolated to a national model. Ambulatory surgery center and hospital outpatient department setting costs were evaluated. MAIN OUTCOMES AND MEASURES: West Tennessee and national Medicare payer costs per patient and the total national Medicare payer cost for DSCS and for ISCS, as well as West Tennessee and national Medicare patient (direct medical, travel, and lost wages) costs for DSCS and for ISCS. RESULTS: Nationally, Medicare was estimated to reduce costs by approximately $522 million with the switch from DSCS to ISCS in 2012. With a change to ISCS, a West Tennessee Medicare patient was estimated to reduce costs by $174 for direct medical costs, $40 for travel costs, and $138 for lost wages (total cost reduction range, $329-$649). The total Medicare-based societal cost reduction was $783 million. CONCLUSIONS AND RELEVANCE: Payers and patients would benefit from an economic standpoint by switching from DSCS to ISCS. Patients and their families would benefit from fewer visits. This becomes important given the increasing number of future cataract surgical procedures that will be performed as the baby boomer generation ages, especially given the fact that Medicare is already financially strained. Further research is needed to evaluate the effect of switching to ISCS from the physician and surgical facility perspectives.
Asunto(s)
Extracción de Catarata/economía , Extracción de Catarata/métodos , Catarata/economía , Costo de Enfermedad , Costos de la Atención en Salud/estadística & datos numéricos , Medicare/economía , Anciano , Análisis Costo-Beneficio , Humanos , Implantación de Lentes Intraoculares , Lentes Intraoculares/economía , Factores Socioeconómicos , Tennessee , Estados UnidosRESUMEN
PURPOSE: To evaluate the posterior capsule opacification (PCO) rates in three different modern standard intraocular lenses (IOL) and analyse the related cost. METHODS: Retrospective study of medical records from 1527 patients who underwent uneventful cataract surgery by phacoemulsification with posterior chamber implantation of either AcrySof SN60 (n = 375), Akreos Adapt (n = 350) or Tecnis Acryl IOL (n = 801). All surgeries were performed by the same surgeon using the same surgical technique and equipment. Primary end-point was neodymium:yttrium-aluminium-garnet (Nd:YAG) capsulotomy for visual impairment secondary to PCO. Cost of IOL material and Nd:YAG capsulotomy for PCO was then evaluated and compared between the IOLs. RESULTS: Mean follow-up was 41.5 months, and the only statistically significant variable of developing PCO was IOL type and individual follow-up time. Nd:YAG capsulotomy was performed in 7.47% in the AcrySof group, 17.71% in the Akreos group and 3.75% in the Tecnis group. Average cost for Nd:YAG capsulotomy per surgery was 18.75 in the AcrySof SN60 group, 44.25 in the Akreos Adapt group and 9.25 in the Tecnis Acryl group. The combined cost of cataract surgery and PCO treatment was 9.81 higher in for the Akreos Adapt group than the other two combined. CONCLUSIONS: This retrospective study shows that the risk of PCO and Nd:YAG capsulotomy is significantly higher in hydrophilic Akreos IOL compared with both AcrySof and Tecnis hydrophobic IOLs. The increased risk of PCO in the hydrophilic IOL is related to higher total average costs for cataract surgery.
Asunto(s)
Opacificación Capsular/epidemiología , Láseres de Estado Sólido/uso terapéutico , Lentes Intraoculares/economía , Facoemulsificación/economía , Capsulotomía Posterior/economía , Trastornos de la Visión/economía , Anciano , Opacificación Capsular/cirugía , Economía Médica , Femenino , Estudios de Seguimiento , Humanos , Implantación de Lentes Intraoculares/economía , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Estudios Retrospectivos , Trastornos de la Visión/rehabilitaciónRESUMEN
PURPOSE: To determine cost identification and acquisition cost comparison of surgical supplies for performing cataract and glaucoma procedures. METHODS: This is a nonrandomized comparative and cross-sectional study. Six health care systems [state-run charity hospital, a private university hospital, 2 ambulatory surgical centers (ASCs), and 2 Veterans Affairs Medical Centers] participated in the study. A list of input prices for disposable surgical items necessary for phacoemulsification with intraocular lens and for trabeculectomy with mitomycin-C (MMC), Ex-PRESS shunt placement, and Ahmed glaucoma valve (AGV) with scleral patch graft was administered to 6 facilities. The total acquisition costs for each surgery at each facility was calculated as the sum of necessary items' costs. All costs are expressed in 2011 US dollars. Total acquisition costs for phacoemulsification/intraocular lens, trabeculectomy with MMC, Ex-PRESS shunt and AGV with scleral patch graft implantation in different health care settings were the main outcome measures. RESULTS: The state-run hospital had the highest overall cost of disposable items for both cataract surgery ($648) and trabeculectomy with MMC ($339), whereas the Veterans Affairs Medical Centers had the lowest acquisition costs for cataract ($386) and the ASC ($96) for trabeculectomy. The ASC system had the lowest cost for both Ex-PRESS shunt ($707) and AGV ($865), whereas the University ($1352 for the Ex-PRESS) and the state ($1338 for AGV) had the highest cost. Average difference between total disposable item acquisition costs and Medicare payment after different surgeries per case is as follows: $544.29 for cataract surgery, $1834.50 for trabeculectomy, $763.30 for Ex-PRESS shunt, and $1315.00 for the AGV surgery. CONCLUSIONS: The ASC system had the lowest acquisition cost for disposable items for both cataract and glaucoma surgeries, whereas the university hospital and the state hospital carried the highest costs on an average. Among the 3 glaucoma procedures compared, trabeculectomy has the lowest acquisition costs for disposable items.
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Catarata/economía , Atención a la Salud , Implantes de Drenaje de Glaucoma/economía , Glaucoma/economía , Lentes Intraoculares/economía , Facoemulsificación/economía , Trabeculectomía/economía , Instituciones de Atención Ambulatoria/economía , Estudios Transversales , Equipos Desechables/economía , Hospitales Provinciales/economía , Hospitales Universitarios/economía , Hospitales de Veteranos/economía , Humanos , Persona de Mediana Edad , Facoemulsificación/instrumentación , Trabeculectomía/instrumentación , Resultado del TratamientoRESUMEN
PURPOSE: To describe the differences in treatment costs for infants randomized to contact lens correction versus primary intraocular lens (IOL) implantation after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). DESIGN: Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid data and the actual costs of supplies used. PARTICIPANTS: The IATS is a randomized, multicenter (n=12) clinical trial comparing treatment of aphakia with a primary IOL or contact lens in 114 infants with unilateral congenital cataract. INTERVENTION: Infants underwent cataract surgery with or without placement of an IOL. MAIN OUTCOME MEASURES: The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 12 months of age. RESULTS: The mean cost of treatment for a unilateral congenital cataract with primary IOL implantation was $14 752 versus $10 726 with contact lens correction. The initial cataract surgery accounted for approximately 50% of the treatment costs for both groups. Contact lens costs accounted for 15% ($1600/patient) in the aphakic group, whereas glasses costs represented only 4% ($535/patient) in the IOL group. The increased costs in the IOL group were primarily due to the higher cost of cataract surgery in this group ($7302 vs. $5357) and the cost of additional operations. CONCLUSIONS: For IATS patients up to 12 months of age, cataract surgery coupled with IOL implantation and spectacle correction was 37.5% (â¼$4000) more expensive than cataract surgery coupled with contact lens correction. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Asunto(s)
Afaquia Poscatarata/economía , Extracción de Catarata/economía , Catarata/congénito , Lentes de Contacto/economía , Lentes Intraoculares/economía , Afaquia Poscatarata/terapia , Análisis Costo-Beneficio , Anteojos/economía , Costos de la Atención en Salud , Investigación sobre Servicios de Salud , Humanos , Lactante , Implantación de Lentes Intraoculares/economía , Seudofaquia/economía , Estudios Retrospectivos , Estados UnidosRESUMEN
BACKGROUND: Patients often pay for specialty intraocular lenses (IOLs) for cataract surgery covered by universal insurance. This practice creates the potential for inequitable pricing where the medical service provider is also the retailer. We measured the variation in prices between cataract surgeons for the same IOL and associated testing. METHODS: We telephoned every cataract surgeon in Ontario, Canada, and asked their price for the most common type of specialty IOL as a prospective patient. We measured the total prices quoted and variation between providers. RESULTS: We contacted 404 ophthalmologists. There were 256 that performed cataract surgery but 127 offered the most commonly employed specialty IOL and would provide a price to patients over the telephone. We obtained prices from all 127 ophthalmologists. Prices for the same lens and associated testing varied substantially between ophthalmologists from $358 to $2790 (median $615, interquartile range $528-$915). There was variation in all components of the total out-of-pocket price, including the price for the IOL itself, charges for uninsured eye measurements, and non-specific supplemental fees. CONCLUSION: Although cataract surgery is covered by public health insurance, some ophthalmologists charge much more than others for the same specialty IOL and associated testing. Greater access to price information and better regulatory control could help ensure patients receive fair value for out-of-pocket health expenses.
Asunto(s)
Extracción de Catarata/economía , Lentes Intraoculares/economía , Honorarios y Precios , Humanos , OntarioRESUMEN
PURPOSE: To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN: Cross-sectional study. METHODS: Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS: Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS: Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP.
Asunto(s)
Extracción de Catarata/economía , Costo de Enfermedad , Financiación Personal/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/economía , Lentes Intraoculares/economía , Servicios de Salud Rural/economía , Población Rural/estadística & datos numéricos , Anciano , China/epidemiología , Estudios Transversales , Honorarios y Precios , Femenino , Investigación sobre Servicios de Salud , Humanos , Implantación de Lentes Intraoculares/economía , Masculino , Encuestas y Cuestionarios , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To analyze and quantify the pattern of corneal astigmatism in patients awaiting cataract surgery and to establish the demand for toric intraocular lenses (IOLs) in a hospital unit. SETTING: Singleton Hospital Abertawe Bro Morgannwg University NHS Trust, Swansea, United Kingdom. DESIGN: Cross-sectional study. METHODS: Keratometric measurements of all patients attending the preassessment clinic over a 4-month period were prospectively collected and analyzed. RESULTS: The study comprised 1230 eyes of 746 patients with a mean age of 75.54 years ± 0.71 (SD). The corneal astigmatism was 0.50 diopter (D) or less in 301 eyes (24.47%), 1.50 D or less in 978 eyes (79.50%), more than 2.50 D in 57 eyes (4.61%), and 3.00 D or more in 24 eyes (1.93%). CONCLUSIONS: Of patients attending for routine cataract surgery at a single center, 497 (40.41%) had more than 1.00 D of astigmatism. The results can help hospitals analyze the demand for and cost of using toric IOLs in patients with corneal astigmatism. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.
Asunto(s)
Astigmatismo/epidemiología , Extracción de Catarata , Catarata/epidemiología , Hospitales de Enseñanza/estadística & datos numéricos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Biometría , Estudios Transversales , Femenino , Humanos , Lentes Intraoculares/economía , Lentes Intraoculares/provisión & distribución , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Refracción Ocular/fisiología , Reino Unido/epidemiología , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: To assess the economic value of improved uncorrected visual acuity among patients with cataract and preexisting astigmatism treated with toric intraocular lenses (IOLs) compared with conventional monofocal IOLs. METHODS: We developed a decision analytic model of hypothetical patients with preexisting astigmatism. We examined costs and outcomes among patients 65 years and older with cataract and preexisting astigmatism (1.5-3.0 diopters) who were receiving either toric or conventional IOLs with and without intraoperative refractive correction (IRC). Data were obtained from the literature and from a survey of 60 US ophthalmologists. Total medical costs of bilateral treatment were calculated for the first posttreatment year and remaining lifetime. Cost-effectiveness and cost-utility outcomes were computed. Future costs and utilities were discounted by 3%. RESULTS: A larger proportion of patients receiving toric IOLs achieved distance vision spectacle independence (67%) and uncorrected visual acuity of 20/25 or better OU (53%) compared with conventional IOLs with (63% and 48%, respectively) or without IRC (53% and 44%, respectively), resulting in fewer future vision corrections. Toric IOLs provided an additional 10.20 quality-adjusted life years (QALYs) compared with conventional IOLs with (10.14 QALYs) and without IRC (10.10 QALYs). Higher first-year costs of the toric IOL ($5739) compared with the conventional IOL with ($5635) or without ($4687) IRC were offset by lifetime cost savings of $34 per patient, $393 per patient achieving uncorrected visual acuity of 20/25 or better, and $349 per QALY compared with the conventional IOL without IRC. CONCLUSIONS: Toric IOLs reduce lifetime economic costs by reducing the need for glasses or contact lenses following cataract removal. These results can inform physicians and patients regarding the value of toric IOLs in the treatment of cataract and preexisting astigmatism.
Asunto(s)
Astigmatismo/economía , Catarata/economía , Técnicas de Apoyo para la Decisión , Costos de la Atención en Salud , Implantación de Lentes Intraoculares/economía , Lentes Intraoculares/economía , Anciano , Astigmatismo/cirugía , Catarata/terapia , Extracción de Catarata , Análisis Costo-Beneficio , Costos y Análisis de Costo , Finlandia , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Humanos , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Estados Unidos , Agudeza Visual/fisiologíaRESUMEN
Recent versions of the International Organization for Standardization (ISO)-based model eye for intraocular lens testing include an artificial cornea whose spherical aberration is chosen to match the value of a human cornea. Aspheric lenses have been used as artificial corneas, but they are expensive and difficult to manufacture. This Letter demonstrates that the aspheric lens can be advantageously replaced with a simple biconvex spherical lens of the same focal length and similar wavefront error. A linear dependence is shown between the Coddington shape factor of the spherical lens and the value of the induced spherical aberration. This relationship is used to match the wavefront error of the spherical lens to the one produced by the aspheric lens. A modified ISO model eye, containing this alternative spherical lens as the artificial cornea, is proposed for the on-axis optical assessment of intraocular lenses. Its suitability for off-axis testing is discussed.
Asunto(s)
Córnea , Lentes Intraoculares , Córnea/fisiología , Córnea/fisiopatología , Aberración de Frente de Onda Corneal , Vidrio , Humanos , Agencias Internacionales/normas , Lentes Intraoculares/economía , Lentes Intraoculares/normasAsunto(s)
Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares/efectos adversos , Astigmatismo/cirugía , Análisis Costo-Beneficio , Femenino , Humanos , Implantación de Lentes Intraoculares/efectos adversos , Implantación de Lentes Intraoculares/economía , Lentes Intraoculares/economía , Masculino , Grupos Raciales , Resultado del TratamientoRESUMEN
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 euro3969, monofocal IOLs euro4123, and Array-SA40 euro5326. Corresponding costs for the NHS were euro2415, euro2555, and euro2556, 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 euro315 for society and euro140 for the NHS.
Asunto(s)
Extracción de Catarata/economía , Implantación de Lentes Intraoculares/economía , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares/economía , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Costos y Análisis de Costo , Anteojos/economía , Anteojos/estadística & datos numéricos , Femenino , Humanos , Masculino , Cadenas de Markov , Modelos Económicos , Países Bajos , Oftalmología/economía , Optometría/economíaRESUMEN
OBJECTIVE: To compare the lifetime costs of freeing astigmatic patients from spectacles after bilateral cataract surgery implanting toric intraocular lenses (IOLs: i.e., Acrysof Toric) versus monofocal IOLs, in France, Italy, Germany and Spain. METHODS: A Markov model followed patient cohorts from cataract surgery until death. Prevalence rates of patients not needing spectacles and the types of spectacles prescribed for those requiring them were obtained from clinical trials and national surveys. The economic perspective was societal. Mortality rates were incorporated into the model. Discount rates were applied. A sensitivity analysis was performed on non-discounted costs. RESULTS: Fewer patients with toric IOLs needed spectacles for distance vision than patients with monofocal IOLs. With monofocal IOLs more than 66% of patients needed complex spectacles compared to less than 25% implanted with toric IOLs. In France and Italy, toric IOLs reduced overall costs relative to otherwise high spectacle costs after cataract surgery. Savings were 897.0 euros (France), 822.5 euros (Germany), 895.8 euros (Italy) and 391.6 euros (Spain), without discounting. On applying a 3% discount rate the costs became 691.7 euros, 646.4 euros, 693.9 euros and 308.2 euros, respectively. CONCLUSIONS: Bilateral toric IOL implants in astigmatic patients decreased spectacle dependence for distance vision and the need for complex spectacles. The economic consequences for patients depended on the national spectacle costs usually incurred after cataract surgery.