Authors: Rami A. Abo-Shasha, Monali Malvankar, Bo Li

Purpose: The purpose of this study is to determine whether wide adoption of multifocal (MF) and/or EDOF IOL implantation is cost-effective in reducing health care cost by reducing the number of falls secondary to bifocal spectacles use. 

Study Design: Cost Effectiveness Analysis 

Methods: The health care cost associated with bifocal spectacles-related falls status post cataract extraction was calculated in the Canadian population, taking into consideration the average cost of emergency visits, average, cost of hospital admissions, and associated hip fracture repairs. The cost associated with multifocal and/or EDOF IOL implantation was generated and compared with the health care costs associated with increased fall risks related to bifocal spectacles use. A theoretical cost-based model was generated and the potential cost savings associated with increased adoption of multifocal and/or EDOF IOL was calculated. 

Results: Approximately 350,000 patients undergo cataract surgery each year in Canada. The use of bifocal spectacles is associated with an 11% increase risk of falls annually. The average patient lives 14 years post-cataract extraction. The total cost of falls over a 14-year period due to bifocal specactles use is $1.0 billion. The estimated cost of population-wise adoption of MF and/or EDOF IOL is $777 million. Therefore, population-wide adoption of MF and/or EDOF IOL has theoretical savings of $223 million on an annual basis. 

Conclusions: Falls are the leading cause of health costs to the Canadian health care system. Increased adoption of multifocal/EDOF IOL implantation in eligible patients undergoing cataract surgery will result in significant health care savings.