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Cost effectiveness of collagen crosslinking for progressive keratoconus in the UK NHS.

AbstractBACKGROUND:
Keratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus.
METHODS:
We constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters.
RESULTS:
Collagen crosslinking is cost effective compared with standard management at an incremental cost of £ 3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £ 33,263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £ 30,000 per QALY.
CONCLUSION:
UVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable.
AuthorsH A Salmon, D Chalk, K Stein, N A Frost
JournalEye (London, England) (Eye (Lond)) Vol. 29 Issue 11 Pg. 1504-11 (Nov 2015) ISSN: 1476-5454 [Electronic] England
PMID26315704 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Cross-Linking Reagents
  • Collagen
Topics
  • Adult
  • Collagen (metabolism)
  • Corneal Stroma (metabolism)
  • Cost-Benefit Analysis
  • Cross-Linking Reagents (economics)
  • Disease Progression
  • Follow-Up Studies
  • Humans
  • Keratoconus (diagnosis, economics, metabolism)
  • Markov Chains
  • National Health Programs (economics)
  • Prospective Studies
  • Quality of Life
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Ultraviolet Rays
  • United Kingdom
  • Young Adult

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