Tan Tien-En, Peh Gary S L, George Benjamin L, Cajucom-Uy Howard Y, Dong Di, Finkelstein Eric A, Mehta Jodhbir S
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore National Eye Centre, Singapore.
Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.
PLoS One. 2014 Jun 20;9(6):e100563. doi: 10.1371/journal.pone.0100563. eCollection 2014.
Corneal endothelial transplantation or endothelial keratoplasty has become the preferred choice of transplantation for patients with corneal blindness due to endothelial dysfunction. Currently, there is a worldwide shortage of transplantable tissue, and demand is expected to increase further with aging populations. Tissue-engineered alternatives are being developed, and are likely to be available soon. However, the cost of these constructs may impair their widespread use. A cost-minimization analysis comparing tissue-engineered constructs to donor tissue procured from eye banks for endothelial keratoplasty was performed. Both initial investment costs and recurring costs were considered in the analysis to arrive at a final tissue cost per transplant. The clinical outcomes of endothelial keratoplasty with tissue-engineered constructs and with donor tissue procured from eye banks were assumed to be equivalent. One-way and probabilistic sensitivity analyses were performed to simulate various possible scenarios, and to determine the robustness of the results. A tissue engineering strategy was cheaper in both investment cost and recurring cost. Tissue-engineered constructs for endothelial keratoplasty could be produced at a cost of US$880 per transplant. In contrast, utilizing donor tissue procured from eye banks for endothelial keratoplasty required US$3,710 per transplant. Sensitivity analyses performed further support the results of this cost-minimization analysis across a wide range of possible scenarios. The use of tissue-engineered constructs for endothelial keratoplasty could potentially increase the supply of transplantable tissue and bring the costs of corneal endothelial transplantation down, making this intervention accessible to a larger group of patients. Tissue-engineering strategies for corneal epithelial constructs or other tissue types, such as pancreatic islet cells, should also be subject to similar pharmacoeconomic analyses.
角膜内皮移植术或内皮角膜移植术已成为因内皮功能障碍导致角膜盲患者的首选移植方式。目前，全球可移植组织短缺，且随着人口老龄化，需求预计还会进一步增加。组织工程替代物正在研发中，可能很快就能投入使用。然而，这些构建物的成本可能会阻碍其广泛应用。我们进行了一项成本最小化分析，比较了用于内皮角膜移植术的组织工程构建物与从眼库获取的供体组织。分析中考虑了初始投资成本和经常性成本，以得出每次移植的最终组织成本。假设使用组织工程构建物和从眼库获取的供体组织进行内皮角膜移植术的临床结果相同。进行了单向和概率敏感性分析，以模拟各种可能情况，并确定结果的稳健性。一种组织工程策略在投资成本和经常性成本方面都更便宜。用于内皮角膜移植术的组织工程构建物每次移植的成本为880美元。相比之下，使用从眼库获取的供体组织进行内皮角膜移植术每次移植需要3710美元。进一步进行的敏感性分析在广泛的可能情况下进一步支持了这项成本最小化分析的结果。使用组织工程构建物进行内皮角膜移植术有可能增加可移植组织的供应，并降低角膜内皮移植的成本，使更多患者能够接受这种治疗。用于角膜上皮构建物或其他组织类型（如胰岛细胞）的组织工程策略也应进行类似的药物经济学分析。
