Microsimulation model analysis found that corneal cross-linking is cost-effective compared with conventional management with penetrating keratoplasty to treat keratoconus.
Microsimulation parameters based on the data found in public literature, published fee codes and expert opinions were applied to simulated cohorts of 100,000 individuals with keratoconus assigned to either corneal cross-linking (CXL) or penetrating keratoplasty (PKP) treatment at the age of 25 years. A life span to a maximum of 110 years was estimated.
The microsimulation model reflected the natural history of keratoconus progression and the impact of conventional management with CXL vs. PKP. From the sum of costs incurred across health states in an individual’s lifetime, the total expected cost sustained by the regional ministry of health, namely the Ontario’s Ministry of Health and Long Term Care, was calculated.
CXL was found to be significantly more cost-effective, although the potential costs and complications related to CXL were maximized in the model, while those associated with PKP were minimized. The average incremental cost-effectiveness ratio (ICER) was Can$9,090/QUALY gained, well below the ICER of other interventions such as the use of implantable cardioverter and defibrillators and spinal deformity surgery, and less than the Canadian threshold (Can$ 20,000 to Can$100,000/QUALY) for cost-effective interventions.
“Because keratoconus is a progressive condition that affects teenagers and young adults in their prime years of productivity, the opportunity to prevent loss of health utility from keratoconus through early CXL has important societal and economic implications,” the authors wrote. – by Michela Cimberle
Disclosure: The authors have no proprietary or commercial interest in any materials discussed in this article.