Cost-Effectiveness Analysis of Corneal Collagen Crosslinking for Progressive Keratoconus.
Ophthalmology
; 124(10): 1485-1495, 2017 10.
Article
em En
| MEDLINE
| ID: mdl-28532974
ABSTRACT
PURPOSE:
To evaluate the cost effectiveness of corneal collagen crosslinking (CXL) for progressive keratoconus from the healthcare payer's perspective.DESIGN:
A probabilistic Markov-type model using data from published clinical trials and cohort studies.PARTICIPANTS:
Two identical cohorts, each comprising 1000 virtual patients with progressive bilateral keratoconus, were modeled; one cohort underwent CXL and the other cohort received no intervention.METHODS:
Both cohorts were modeled and evaluated annually over a lifetime. Quality-adjusted life years (QALYs), total cost, disease progression, and the probability of corneal transplantation, graft failure, or both were calculated based on data from published trials and cohort studies. These outcomes were compared between the 2 cohorts. In our base scenario, the stabilizing effect of CXL was assumed to be 10 years; however, longer durations also were analyzed. One-way sensitivity analyses were performed to test the robustness of the outcomes. MAIN OUTCOMEMEASURE:
Incremental cost-effectiveness ratio (ICER), defined as euros per QALY.RESULTS:
Assuming a 10-year effect of CXL, the ICER was 54 384/QALY ($59 822/QALY). When we adjusted the effect of CXL to a lifelong stabilizing effect, the ICER decreased to 10 149/QALY ($11 163/QALY). Other sensitivity and scenario analyses that had a relevant impact on ICER included the discount rate, visual acuity before CXL, and healthcare costs.CONCLUSIONS:
Corneal collagen crosslinking for progressive keratoconus is cost effective at a willingness-to-pay threshold of 3 times the current gross domestic product (GDP) per capita. Moreover, a longer stabilizing effect of CXL increases cost effectiveness. If CXL had a stabilizing effect on keratoconus of 15 years or longer, then the ICER would be less than the 1 × GDP per capita threshold and thus very cost effective.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fotoquimioterapia
/
Colágeno
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Análise Custo-Benefício
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Fármacos Fotossensibilizantes
/
Substância Própria
/
Reagentes de Ligações Cruzadas
/
Ceratocone
Tipo de estudo:
Health_economic_evaluation
/
Observational_studies
/
Prognostic_studies
Limite:
Adult
/
Humans
/
Middle aged
Idioma:
En
Revista:
Ophthalmology
Ano de publicação:
2017
Tipo de documento:
Article