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Economic appraisal of prosthetic replacement of ocular surface ecosystem in Canada

Poster Details

First Author: A. Garg CANADA

Co Author(s):    B. Wong   T. Trinh   S. Ramdass   J. Liao   C. Chan   A. Slomovic     

Abstract Details


To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) lens in patients with distorted corneal surface or ocular surface disease in Canada.


The study site was the PROSE Clinic at Kensington Eye Institute and affiliated with the University of Toronto.


Retrospective non-randomized unmasked observational cohort study. Visual acuity outcomes of 76 patients who received a PROSE device from the only PROSE clinic in Canada from 2018 to 2020 were assessed. Cost, cost utility, and benefit-cost analyses were performed to assess the value provided by PROSE. Benefits were defined as improvements in visual acuity which were converted into utilities then quality-adjusted life years (QALYs). Economic values were derived via government statements, the clinicメs financial statements, and published literature.


Average BCVA improvement was -0.42ᄆ0.41 logMAR (p=2.68*10-13) or Snellen 20/53 for the overall cohort, -0.51ᄆ0.48 (p=5.42*10-8) or Snellen 20/65 for distorted corneal surface patients, and -0.31ᄆ0.30 (p=1.30*10-7) or Snellen 20/41 for ocular surface disease patients. Average fitting cost was $5,469.85, of which $4,971.38 was clinic cost and $498.47 was patient cost. Cost utility was favourable, at $10,256.47 for the overall cohort, $8,439.79 for distorted corneal surface patients, and $13,069.90 for ocular surface disease patients. Benefit-cost ratio was also favourable, at 34.4 for all patients, 43.8 for distorted corneal surface patients, and 28.3 for ocular surface disease patients.


Our economic appraisal demonstrated that PROSE treatment provided a significant, cost-effective benefit to patients with distorted corneal surfaces and ocular surface diseases. This indicates that PROSE clinics are an efficient investment of health care funding. This benefit was more pronounced than observed in a previous economic appraisal published in 2009 due to increased FDA valuation of a life, reduced device costs, and lower clinical service costs. A long-term prospective study in which VFQ-25 data is collected over several years is recommended to more accurately determine value provided by and the lifespan of a PROSE device.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a competing company

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