Cost-Effectiveness Analysis of Implantable Collamer Lens (ICL) Surgery Versus Contact Lens-Based Correction with Backup Spectacles in Young Adults—A Norwegian Societal Perspective

Background: Moderate-to-high refractive error generates long-term direct and indirect costs through corrective devices, complications, and productivity losses. The economic value of implantable collamer lens (ICL) surgery relative to contact lens (CL)-based correction with backup spectacles remains uncertain. Objective: To evaluate the 25-year cost-effectiveness of posterior chamber phakic ICL implantation versus CL-based correction across four refractive subgroups from a Norwegian societal perspective. Methods: A Markov cohort model followed patients aged 25–50 years with high myopia, high myopia with astigmatism, high hyperopia, or high hyperopia with astigmatism. Health states incorporated surgical complications, microbial keratitis (MK), cataract, explantation, and death. Direct medical and productivity costs were valued in 2024 Norwegian kroner (NOK), converted to United States dollars (USD), and subsequently reported in USD. Outcomes included quality-adjusted life-years (QALYs), incremental costs, incremental net monetary benefit (INMB), and cost-effectiveness probabilities at Norwegian severity-based thresholds (NOK 250,000–825,000/QALY). Deterministic and probabilistic sensitivity analyses were performed. Results: In the deterministic base case, ICL was less costly and more effective in all subgroups. Incremental QALY gains ranged from 0.049 to 0.464, and 25-year savings ranged from USD 1758 to USD 2277 per patient. At USD 27,253/QALY, INMB ranged from USD 3264 to USD 14,921. ICL produced approximately 5–6 additional cataract surgeries per 100 patients but avoided approximately 1.1–1.3 MK infections per 100 CL users and provided 0.6–0.9 additional years in the “Well” state. Cost-effectiveness probabilities ranged from 52.7% to 74.2% and were highest in the astigmatic subgroups. Utilities were the principal uncertainty drivers; the 52.7% probability observed for high hyperopia indicated limited robustness. Conclusions: Over 25 years, ICL may provide cost savings and quality-of-life gains compared with CL-based correction in appropriately selected patients. These findings depend on model assumptions and should not be interpreted as a lifetime evaluation.