• Early CXL More Cost-Effective Than PKP for Keratoconus

    Written By: Lynda Seminara and selected by Stephen D. McLeod, MD

    Journal Highlights

    Ophthalmology, August 2017

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    Although penetrating keratoplasty (PKP) is currently the most common corneal transplantation for advanced keratoconus, corneal collagen cross-linking (CXL) may prevent disease progression in patients with early keratoconus, potential­ly obviating transplantation and preserving vision. Leung et al. performed a cost-ef­fectiveness analysis in which simulated cohorts of patients with keratoconus were treated with CXL or conven­tional PKP. They found early treatment with CXL to be a cost-effective alternative to PKP, and they also noted that their results corroborated those of another study.

    The authors created state-transition microsimulation models in which 100,000 individuals were diagnosed with keratoconus at age 25 and were managed by either modality. Health status and costs incurred were assessed monthly until death. Costs were evaluated from the perspective of a public third-party payer and included expenses for follow-up, diagnostic tests, and other procedures. Discounting of costs and health benefits (by 5%) was applied to account for expectations beyond the first year. Relative costs incurred versus quality-adjusted life years (QALYs) gained were expressed as incremental cost-effectiveness ratios (ICERs), with $20,000 in Canadian currency (Can$) to $100,000/QALY considered cost-effective.

    Even under conservative condi­tions, in which the potential costs and complications of CXL were maximized while those of PKP were minimized, early CXL proved cost-effective. The average lifetime cost of CXL was Can$5,530, with 50.12 QALYs gained per patient (discounted: Can$4,512, 16.42 QALYs). The cost for PKP was Can$2,675, with 48.93 QALYs gained (discounted: Can$1,508, 16.09 QA­LYs). The average discounted ICER for CXL versus PKP was Can$9,090/QALY gained. Sensitivity analyses indicated that CXL’s cost-effectiveness was supe­rior for 40 of the 42 tested scenarios.

    The original article can be found here.