Economic Evaluation of Intraocular Lens Targeting Cataract Patients: A Review and Future Directions.

Abstract

Purpose: Cataracts remain the leading global cause of blindness, disproportionately affecting aging populations and imposing substantial economic burdens. With the widespread adoption of intraocular lens (IOLs) implantation in cataract surgery, rigorous health economic evaluations are imperative to inform clinical decision making and resource allocation across diverse healthcare systems.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, encompassing PubMed, Web of Science, CNKI, and other databases, alongside reports from international health technology assessment agencies (May 2024). Fourteen studies (2001-2022) across 12 countries were included after screening 436 records. Data extraction adhered to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist, with methodological quality assessed via the Drummond tool. Analyses focused on cost-effectiveness analysis (CEA), cost-utility analysis (CUA), and incremental cost-effectiveness ratios (ICERs), incorporating Markov models and sensitivity analyses.

Results: Multifocal IOLs demonstrated superior cost-effectiveness compared to monofocal IOLs, with ICERs well below established thresholds (e.g. $4805/quality-adjusted life years (QALY) in the United States vs. $50,000/QALY). Lifetime societal costs for multifocal IOLs ranged from $5780.79 to $15,944.76, yielding QALY gains of 0.16 to 0.71 and spectacle-independence rates of 86.0% to 90.9% versus 8.5% to 31.8% for monofocal IOLs. Hydrophobic acrylic lenses outperformed other materials (Nd:YAG laser intervention rates = 7.1% vs. 31.1% for hydrophilic acrylic), whereas scleral-fixated IOLs justified higher costs by preserving endothelial cells (ICER = €3.72/cell). Toric IOLs showed regional variability, with long-term cost savings in the United States ($349/QALY) but limited viability in the Netherlands (1-15% probability at €20,000/QALY). Heterogeneity arose from methodological differences, short-term utility assumptions, and contextual factors (e.g. reimbursement policies).

Conclusions: Advanced IOLs, particularly multifocal and hydrophobic acrylic variants, are cost-effective for patients prioritizing spectacle independence and long-term visual outcomes. However, economic viability is context-dependent, necessitating region-specific analyses that integrate real-world data, patient preferences, and indirect costs (e.g. productivity loss). Future research should prioritize lifecycle assessments, equity-focused models, and low- and middle-income countries' (LMIC) perspectives to bridge existing evidence gaps and guide sustainable policy decisions.

Translational relevance: This review bridges health economics and clinical practice by evaluating the cost-effectiveness of advanced IOLs across different healthcare systems, offering insights for optimizing IOLs selection based on patient needs and economic contexts. It also highlights critical evidence gaps in LMICs, urging future research to incorporate real-world data and patient preferences for more sustainable cataract care.