Hansen Lucca Ortolan, Garcia Renato, Torricelli André Augusto Miranda, Bechara Samir Jacob
Division of Ophthalmology, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil.
Int J Environ Res Public Health. 2024 Nov 26;21(12):1569. doi: 10.3390/ijerph21121569.
Keratoconus is a burden to health systems and patients worldwide. Corneal collagen crosslinking (CXL) treatment has been shown abroad to be cost-effective for treating progressive keratoconus. However, no cost-effectiveness studies have been performed in Brazil. The aim of this study was to assess the cost-effectiveness of corneal collagen crosslinking (CXL) compared with the conventional treatment for progressive keratoconus from the Brazilian Unified Health System (SUS) payer's perspective. A lifetime microsimulation model was utilized to compare the lifetime costs and quality-adjusted life years for patients undergoing corneal collagen CXL or conventional treatment. Two groups of 5000 18-year-old patients were simulated, with one group receiving corneal CXL at the outset and the control group remaining untreated. The TreeAge Pro Healthcare 2024 software was used for modeling and analysis. Corneal collagen CXL demonstrated superior cost-effectiveness compared to the conventional treatment, with an incremental cost-effectiveness ratio of 58.26 USD/quality-adjusted life years (QALY) gained (95% CI: 58.17-58.36) and a positive incremental net monetary benefit of USD 11,613.82 (95% CI: 11,605.66-11,621.99). CXL significantly reduced the number of required corneal transplants, with a mean of 968.8 (95% CI: 959-978.58) fewer transplants per 10,000 eyes treated. The variable with the most significant impact on the incremental net monetary benefit was the duration of the CXL effect. This study concluded that corneal CXL is a highly cost-effective intervention for progressive keratoconus within the Brazilian SUS. These findings advocate for broader accessibility to this vision-saving treatment within the SUS.
圆锥角膜给全球的卫生系统和患者都带来了负担。国外研究表明，角膜胶原交联（CXL）治疗对于进行性圆锥角膜具有成本效益。然而，巴西尚未开展成本效益研究。本研究旨在从巴西统一卫生系统（SUS）支付方的角度，评估角膜胶原交联（CXL）与进行性圆锥角膜传统治疗方法相比的成本效益。采用终生微观模拟模型，比较接受角膜胶原CXL治疗或传统治疗患者的终生成本和质量调整生命年。模拟了两组各5000名18岁患者，一组一开始就接受角膜CXL治疗，对照组不接受治疗。使用TreeAge Pro Healthcare 2024软件进行建模和分析。与传统治疗相比，角膜胶原CXL显示出更高的成本效益，增量成本效益比为每获得一个质量调整生命年（QALY）58.26美元（95%可信区间：58.17 - 58.36），增量净货币效益为11,613.82美元（95%可信区间：11,605.66 - 11,621.99）。CXL显著减少了所需角膜移植的数量，每10,000只接受治疗的眼睛平均减少968.8例（95%可信区间：959 - 978.58）。对增量净货币效益影响最大的变量是CXL效果的持续时间。本研究得出结论，在巴西SUS范围内，角膜CXL是治疗进行性圆锥角膜极具成本效益的干预措施。这些研究结果主张在SUS范围内更广泛地提供这种挽救视力的治疗方法。
