Modelling lifetime cost consequences of ReSTOR for presbyopia in four European countries

Abstract

Aims To compare the lifetime cost consequences, in France, Italy, Germany and Spain, of liberating presbyopic patients from spectacles by implanting the multifocal intraocular lens ReSTOR®. Methods A Markov model was created to compare a patient cohort implanted with ReSTOR at age 45 years, with a cohort using spectacles, until death or age 100 years. Prevalence rates of patients not requiring spectacles after surgery were obtained from clinical trials. Resource utilisation included implant surgery, spectacles, visits to ophthalmologists and optic centres, transport and time lost by patients. Economic perspectives were those of society and sickness funds. Mortality rates were introduced into the model. Cataract surgery was allowed just for the spectacles-only cohort. Results Rate of spectacle independence was fixed at 80% for ReSTOR. When time spent to care for refraction was not taken into account, lifelong ReSTOR cost was higher than spectacles in all countries (ε293; ε1013), according to the societal perspective. When time was included, cost saving was observed in Italy (ε136) and the incremental cost to be free of spectacles comprised between ε11 and ε816. According to the NHS perspective, ReSTOR is a cost saving strategy (ε274; ε605). Conclusions At a 3% discount rate, savings achieved by liberating patients from spectacles counterbalanced partially the initially higher cost of ReSTOR according to the society perspective. ReSTOR could be considered as cost-effective in the four countries provided that the willingness to pay of patients to be free of spectacles would be lower than ε23.65/year. © 2009 Macmillan Publishers Limited All rights reserved.