Cost-Effectiveness of Presbyopia Correction Among Seven Strategies of Bilateral Cataract Surgery Based on a Prospective Single-Blind Two-Center Trial in China

Qianqian Lan, Yiyun Liu, Fan Xu, Min Li, Yaxin Li, Tingting Yang, Tong Sun, Gang Yao, Baikai Ma, Liyuan Tao, Xin Xiao, Xing Lin Feng, Siming Zeng, Hong Qi, Qianqian Lan, Yiyun Liu, Fan Xu, Min Li, Yaxin Li, Tingting Yang, Tong Sun, Gang Yao, Baikai Ma, Liyuan Tao, Xin Xiao, Xing Lin Feng, Siming Zeng, Hong Qi

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).

Keywords: Average cost-effectiveness ratio; Cataract surgery; Cost-effectiveness analysis; Incremental cost-effectiveness ratios; Objective spectacle independence; Presbyopia correction.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flow diagram of ICERs in pairwise comparisons. The term “dominates” indicates the strategy is cost-effective with higher effectiveness at a lower cost compared with the other strategy. The cost-effective and very cost-effective thresholds were defined as $16,440/10% incremental rates and $5480/10% incremental rates, respectively. Abbreviations: “Rate” is the shortened form of objective spectacle independence rate; “E” is the shortened form of effectiveness (objective spectacle independence rates, %); “C” is the shortened form of total cost ($/patient); EDOF, extended depth of focus; ICER, incremental cost-effectiveness ratio; VS, versus; $, US dollar
Fig. 2
Fig. 2
Cost-effectiveness plane. The scatter points represent the 1000 pairs of incremental cost (total cost) and incremental effectiveness (objective spectacle independence rate). The WTP lines representing the thresholds of cost-effective (WTP of $16,440/10% incremental rates) and very cost-effective (WTP of $5480/10% incremental rates). A The blended strategy compared with the monovision strategy. B The refractive bifocal strategy compared with the blended strategy. C The trifocal strategy compared with the refractive bifocal strategy. Abbreviations: “Rate” is the shortened form of objective spectacle independence rate; WTP, willingness-to-pay; $, US dollar
Fig. 3
Fig. 3
Cost-effectiveness acceptability curves showing the probability (y-axis) that the strategy is cost-effective at different WTP thresholds per 10% incremental objective spectacle independence rates (x-axis). Abbreviations: WTP, willingness-to-pay; $, US dollar

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