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Cost‐effectiveness analysis in a randomized trial of late in‐the‐bag intraocular lens dislocation surgery: repositioning versus exchange
Author(s) -
Kristianslund Olav,
Dalby Marius,
Moe Morten C.,
Drolsum Liv
Publication year - 2019
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.14108
Subject(s) - medicine , intraocular lens , confidence interval , randomized controlled trial , significant difference , mean difference , visual acuity , cost effectiveness , vitrectomy , surgery , ophthalmology , risk analysis (engineering)
Purpose To compare the cost‐effectiveness of two operation methods for late in‐the‐bag intraocular lens ( IOL ) dislocation. Methods In this randomized clinical trial, 104 patients were randomly assigned to IOL repositioning by scleral suturing ( n = 54) or IOL exchange with a retropupillary iris‐claw lens ( n = 50). A cost‐effectiveness analysis ( CEA ) was performed in conjunction with previously published 6‐month efficacy and safety results. An incremental cost‐effectiveness ratio was calculated as the cost difference between the operation groups relative to their difference in postoperative corrected distance visual acuity ( CDVA ) (mean and 95% confidence interval: minimum and maximum), reported as the cost difference in United States Dollars ($) per log MAR difference. Results Exchange surgery was $281.20 ± 17.66 more expensive than repositioning, mainly explained by the new IOL and the frequent use of anterior vitrectomy. A previous trial publication revealed no significant difference in the 6‐month postoperative CDVA between the groups. In the CEA , the mean group difference yielded an incremental cost‐effectiveness ratio of −$281.20 per −0.11 log MAR (‐$1108/ QALY ) in favour of repositioning, ranging from −$281.20 per −0.29 log MAR (‐$406/ QALY ) in favour of repositioning to +$281.20 per −0.08 log MAR (+$1522/ QALY ) in favour of exchange. The CEA did not include the mean 9.5 min shorter operation time for exchange. Conclusion Repositioning tended to be more cost‐effective than exchange; however, this is modified if also considering the operation time. Overall, it seems the cost‐effectiveness is not alone sufficiently different to recommend one of the operation methods over the other for late in‐the‐bag IOL dislocation.