Socioeconomic aspects of laser in situ keratomileusis, eyeglasses, and contact lenses in mild to moderate myopia

Abstract

Purpose To compare the societal costs and consequences of 3 strategies to correct mild to moderate myopia: laser in situ keratomileusis (LASIK), eyeglasses, and contact lenses (CLs). Setting Instituto Oftalmológico de Alicante, Alicante, Spain. Methods A Markov model was set up to compare the present value of LASIK, eyeglasses, and CLs. A structured questionnaire was administered to 40 consecutive patients with mild to moderate myopia to collect resource information including direct medical and nonmedical costs as well as indirect costs (transportation, time spent, hotel, eyeglasses, CLs, LASIK, cleaning products, visits to ophthalmologist/optometrist/optical center, and adverse events linked to LASIK and CLs). The time period ranged from 10 to 30 years with a 5% discount rate. The Spanish population was used as the basis for the economic data. Full sensitivity analyses were conducted. Results Based on the time period, LASIK saved from 18 to 278 km in distance to care centers compared with eyeglasses and from 405 to 1436 km compared with CLs. The time to care for visual acuity was similar between LASIK and CLs, but up to 1180 additional hours were spent by CL users. Laser in situ keratomileusis saved from 4.69 to 12.07 eyeglasses and from 28 to 84 eyeglass cleaning packs. With LASIK, there were 18 to 50 visits to the optical center compared with 41 to 117 visits with CLs. Laser in situ keratomileusis saved 4.7 to 12.2 visits to correct visual acuity compared with eyeglasses and CLs. It prevented 95 to 295 per 10 000 cases of CL-related keratitis. Contact lenses were always more costly than LASIK, which was always more costly than eyeglasses. The 2 sensitivity parameters were time period and discount rate. Conclusion Laser in situ keratomileusis was less costly than CLs and more expensive than eyeglasses, although the potential nonmonetary benefit of LASIK over eyeglasses was not taken into account.