PS 1-10 CORNEAL CROSS-LINKING VERSUS PENETRATING KERATOPLASTY IN THE TREATMENT OF KERATOCONUS: A COST-EFFECTIVENESS ANALYSIS

Sunday, October 23, 2016
Bayshore Ballroom ABC, Lobby Level (Westin Bayshore Vancouver)
Poster Board # PS 1-10

Victoria Leung, MD1, Petros Pechlivanoglou, MSc, PhD2, Hall Chew, MD FRCSC1, Murray D. Krahn, MD, MSc3 and Wendy Hatch, OD, MSc1, (1)Department of Ophthalmology and Vision Sciences, Toronto, ON, Canada, (2)Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada, (3)University of Toronto and University Health Network, Toronto General Research Institute, Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, ON, Canada
Purpose: Keratoconus is a chronic, bilateral disease characterized by a conical corneal shape that can result in significant visual impairment. Conventional management for patients with keratoconus involves the use of spectacles and contact lenses and, when needed, penetrating keratoplasty (PKP). Corneal collagen cross-linking (CXL) is a novel treatment that increases corneal rigidity and thereby halts the progression of keratoconus. We conducted a cost-effectiveness analysis to compare CXL to conventional management for patients with keratoconus.

Method: We designed two state-transition microsimulation models to capture the natural history of keratoconus and the impact of CXL versus conventional management. In each treatment arm, 100,000 simulated 25 year-olds transitioned through health states in monthly cycles from time of diagnosis until death. We assumed all individuals in the CXL treatment arm undergo CXL at diagnosis. Individuals receiving conventional management experienced the natural progression of keratoconus, with approximately a 20% risk of undergoing PKP. We conducted the analysis from the Ontario public healthcare payer perspective, using a 5% discount rate.  Each model included the following health states: 1. Keratoconus managed with spectacles and contact lenses (conventional management)); 2. Surgical intervention (CXL or PKP); 3. Post-operative success; 4. Post-operative vision loss/minor complication; 5. Post-operative irreversible vision loss/major complication (conventional management); 6. Graft rejection (Conventional management and 7. Death. Transition probabilities were extracted from long-term longitudinal keratoconus studies. We compared the total discounted costs and quality-adjusted life years (QALYs) associated with each treatment strategy using an incremental cost-effectiveness ratio (ICER). Univariate sensitivity analyses were conducted.

Result:

The expected costs and utilities associated with CXL were: $1,855CAD ($1,784 CAD, discounted) and 48.03 QALYs (15.78 QALYs, discounted), respectively. PKP lifetime costs and QALYs gained were $1,982 CAD ($1176 CAD, discounted) and 47.87 QALYs (15.76 QALYs, discounted). We calculated a comparative ICER of $22,097 per QALY gained from CXL. Sensitivity analysis indicated that the ICER is most sensitive to the cost and the effectiveness of CXL.

Conclusion:

When compared to other interventions currently reimbursed by the public healthcare payer, CXL is a cost-effective alternative to conventional management of keratoconus. This study is the first to provide economic evidence to support the adoption of CXL.

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