gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Incremental cost effectiveness: a rationale for discussions with health-care insurances in ophthalmology?

Meeting Abstract

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  • corresponding author F. Krummenauer - Department for Medical Biometry, Epidemiology and Informatics, University of Mainz

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogFR.08.06

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Veröffentlicht: 22. September 2004

© 2004 Krummenauer.
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The health economic evaluation of therapeutic and diagnostic strategies is of increasing importance. However, discussions with health care insurances sometimes lack from objective rationales to quantify the cost effectiveness of concepts under consideration. Target parameters would be desirable, which enable to rank the cost effectiveness of new procedures along those of already established ones.


Different procedures in ophthalmic surgery (cataract surgery using monofocal and multifocal intraocular lenses, LASIK, LASEK etc.) will be contrasted from a health economic perspective to illustrate the principle concepts of incremental cost effectiveness ratios (ICERs) and incremental net health benefits (INHBs). ICERs relate the costs of a treatment to its clinical benefit in terms of a ratio expression [indexed as€ per clinical benefit unit]; therefore ICERs can be directly compared to a pre-specified willingness to pay benchmark, which represents the maximum costs, a health insurer would invest to achieve one clinical benefit unit. INHBs involve these benchmarks into estimation of a therapy's total clinical benefit after accountig for its cost increase versus an established therapeutic standard. Therefore both strategies crucially call for pre-specification of the underlying clinical benefit endpoint and the willingness to pay benchmark to avoid inconsistent findings.


If the clinical benefit of cataract surgery is assessed by the post operative gain in visual acuity, incremental costs of 230€ per gained line are invested when implanting monofcal intraocular lenses. If, however, the benefit of cataract surgery is estimated by its achieved number of quality adjusted life years (QALYs), incremental costs of 1926€ per QALY are invested. This demonstrates the sensitivity of cost effectiveness against a change of the clinical benefit endpoint. If furthermore the benefit of a LASIK procedure is characterized by the gained refractive change, the resulting incremental costs amount to 740€ per gained diopter. Based on the LASIK-associated increase in visual acuity, however, incremental costs range about 270€ per gained vision line, which closely corresponds to the cost effectiveness of monofocal cataract surgery (despite the two procedures' different status concerning reimburesement decisions by health care insurances).


The use of incremental cost effectiveness and net health benefit estimates as an objective rationale for health economic discussions essentially affords the priori determination of appropriate clinical benefit endpoints for the underlying cost effectiveness evaluation.