Abstract | BACKGROUND:
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.
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Authors | H A Salmon, D Chalk, K Stein, N A Frost |
Journal | Eye (London, England)
(Eye (Lond))
Vol. 29
Issue 11
Pg. 1504-11
(Nov 2015)
ISSN: 1476-5454 [Electronic] England |
PMID | 26315704
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Chemical References |
- Cross-Linking Reagents
- Collagen
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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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