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Cost-effectiveness of corneal cross-linking for progressive keratoconus

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Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:30

Paper Time: 15:48

Venue: Room 4.6

First Author: : D.Godefrooij THE NETHERLANDS

Co Author(s): :    M. Mangen   E. Chan   D. O'Brart   S. Imhof   A. de Wit   R. Wisse     

Abstract Details

Purpose:

To evaluate the cost-effectiveness of corneal crosslinking (CXL) for progressive keratoconus from a healthcare payer perspective

Setting:

Multicenter modeling study conducted in UMC Utrecht with patient data from Guy's and St. Thomas Hospital, UK, Royal Victorian Eye and Ear Hospital, AUS, and the CLEK database, US.

Methods:

Two identical virtual cohorts (CXL and non-intervention) of 1000 patients with progressive bilateral keratoconus, were evaluated using a probabilistic Markov-type model. Quality-adjusted life years (QALYs), costs, disease progression and the chance of corneal transplantation/failure were based on data from peer-reviewed, published trials and cohort studies. CXL effect was assumed to last seven years, but longer durations were studied in scenario analyses. Sensitivity analyses were performed to test robustness of outcomes.

Results:

When assuming a stabilizing effect of seven years the ICER of CXL was €77.876/QALY ($85.664/QALY). The ICER was strongly influenced by the duration of CXL effectiveness. If a lifelong stabilizing effect was assumed the ICER would decrease to €10.149 ($11.163). Other sensitivity and scenario analyses with a relevant impact on the ICER were discounting, the pre-CXL visual acuity and healthcare costs.

Conclusions:

CXL for progressive keratoconus is cost-effective at a willingness-to-pay threshold of €115.518 ($127.070) (i.e. three times the gross domestic product (GDP) / capita). Longer stabilizing effects of CXL would result in lower ICERs; If CXL would have a lifetime stabilizing effect on keratoconus the treatment would be under the one time GDP / capita threshold, and thus very cost effective.

Financial Disclosure:

NONE

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