Utrecht Cornea Research Group, Department of Ophthalmology, University Medical Center Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
Ophthalmology. 2017 Oct;124(10):1485-1495. doi: 10.1016/j.ophtha.2017.04.011. Epub 2017 May 19.
To evaluate the cost effectiveness of corneal collagen crosslinking (CXL) for progressive keratoconus from the healthcare payer's perspective.
A probabilistic Markov-type model using data from published clinical trials and cohort studies.
Two identical cohorts, each comprising 1000 virtual patients with progressive bilateral keratoconus, were modeled; one cohort underwent CXL and the other cohort received no intervention.
Both cohorts were modeled and evaluated annually over a lifetime. Quality-adjusted life years (QALYs), total cost, disease progression, and the probability of corneal transplantation, graft failure, or both were calculated based on data from published trials and cohort studies. These outcomes were compared between the 2 cohorts. In our base scenario, the stabilizing effect of CXL was assumed to be 10 years; however, longer durations also were analyzed. One-way sensitivity analyses were performed to test the robustness of the outcomes.
Incremental cost-effectiveness ratio (ICER), defined as euros per QALY.
Assuming a 10-year effect of CXL, the ICER was €54 384/QALY ($59 822/QALY). When we adjusted the effect of CXL to a lifelong stabilizing effect, the ICER decreased to €10 149/QALY ($11 163/QALY). Other sensitivity and scenario analyses that had a relevant impact on ICER included the discount rate, visual acuity before CXL, and healthcare costs.
Corneal collagen crosslinking for progressive keratoconus is cost effective at a willingness-to-pay threshold of 3 times the current gross domestic product (GDP) per capita. Moreover, a longer stabilizing effect of CXL increases cost effectiveness. If CXL had a stabilizing effect on keratoconus of 15 years or longer, then the ICER would be less than the 1 × GDP per capita threshold and thus very cost effective.
从医疗保健支付者的角度评估角膜交联术（CXL）治疗进行性圆锥角膜的成本效果。
使用来自已发表临床试验和队列研究的数据，采用概率马尔可夫模型。
对 2 个相同的队列进行建模，每个队列都包含 1000 名患有双侧进行性圆锥角膜的虚拟患者；其中一个队列接受 CXL，另一个队列不接受任何干预。
对这两个队列进行建模，并在其一生中每年进行评估。根据来自已发表的试验和队列研究的数据，计算了质量调整生命年（QALY）、总成本、疾病进展以及角膜移植、移植物失败或两者同时发生的概率。比较了这两个队列之间的结果。在我们的基本情况下，假设 CXL 的稳定效果持续 10 年；然而，也分析了更长的持续时间。进行了单因素敏感性分析以测试结果的稳健性。
增量成本效果比（ICER），定义为每 QALY 的欧元。
假设 CXL 的效果持续 10 年，ICER 为 54384 欧元/QALY（59822 美元/QALY）。当我们将 CXL 的效果调整为终生稳定效果时，ICER 降低至 10149 欧元/QALY（11163 美元/QALY）。对 ICER 有重大影响的其他敏感性和情景分析包括贴现率、CXL 前的视力和医疗保健成本。
对于进行性圆锥角膜，角膜交联术的成本效果在 3 倍当前人均国内生产总值（GDP）的支付意愿阈值内是合理的。此外，CXL 更长的稳定效果可提高成本效果。如果 CXL 对圆锥角膜的稳定效果为 15 年或更长时间，则 ICER 将低于 1 倍人均 GDP 阈值，因此非常具有成本效益。
