Paul Athanasiov, Chandra Bala, Jason Holland, Mukesh Dhariwal, Amit Gupta, Hemant Rathi

Purpose: AcrySof IQ Vivity is the first and only extended depth of focus (EDOF) intraocular lens (IOL) with the Wavefront-Shaping X-WAVE technology and a clinically proven monofocal visual disturbance profile. This study estimates the cost-effectiveness of AcrySof IQ Vivity IOL vs standard aspheric monofocal IOL, from a private health fund perspective in Australia.

Methods: A Markov model was developed using the fol- lowing health states: well, need for spectacles (near/dis- tance/multifocal), severe visual disturbances – with/ without spectacles, and death. Model inputs were sourced from a randomised clinical study (NCT03010254), publi- shed literature and expert opinion. IOL costs (AcrySof IQ Vivity AU$651, and AcrySof SN60WF AU$290) were derived from the published prostheses list. A lifetime time horizon (30 years) was considered, and cost and health outcomes were discounted at 5% per annum. Model outcomes included incremental cost-effectiveness ratio per quality adjusted life year (QALY) gain. Sensitiviity and scenario analyses were also conducted.

Results: Bilateral implantation of AcrySof IQ Vivity IOL provided QALY gain of 0.16 at an incremental lifetime cost of AU$384 vs. monofocal IOL leading to incremental cost-effectiveness ratio of AU$2,383/QALY, which is well below the cost-effectiveness thresholds (range: AU
$45,000-AU$75,000) typically used by Medical Services Advisory Committee Australia. Results were sensitive to the cost of IOL prosthesis, post-operative spectacle dependence, and disutility due to wearing glasses. The robust- ness of results was further confirmed by probabilistic sensitivity analysis and scenario analyses..

Conclusions: AcrySof IQ Vivity IOL is a highly cost effective treatment strategy with improved vision-related
quality of life outcomes for patients undergoing cataract surgery.