Cost-benefit study of CXL

[caption id="attachment_8414" align="alignnone" width="325"] Daniel A Godefrooij MD[/caption] Corneal crosslinking (CXL) is cost-effective in the treatment of patients with progressive keratoconus, suggests a comparison study presented at the 21st ESCRS Winter Meeting in Maastricht, The Netherlands. Using a probabilistic-type stochastic Markov-type model, the study compared two identical cohorts, each including 1,000 virtual patients with progressive bilateral keratoconus. One cohort received CXL and the other cohort received no initial intervention, said Daniel A Godefrooij MD, University Medical Center Utrecht, The Netherlands. He noted that the study modelled the patients and their virtual annual evaluations based on data from published trials and cohort studies over a lifetime. They took into account disease progression, and the probability of corneal transplantation and/or graft failure. The analysis showed that, assuming a 10-year duration of effect, CXL is cost-effective for progressive keratoconus at a willingness-to-pay threshold of €115,518, which is three times the current gross domestic product (GDP) per capita. Moreover, assuming a longer stabilising effect of CXL would increase the cost-effectiveness, Dr Godefrooij noted. “We assumed that the longest duration of crosslinking effectiveness will be 10 years, which is the longest follow-up published, but we did not see a degeneration of the crosslinking effect, so it's plausible that the effect is longer than 10 years,” he said. He noted that assuming a 10-year effect of CXL, the incremental cost-effectiveness ratio (ICER) – the difference in cost between two possible interventions divided by the difference in their effect – was €54,384 per quality-adjusted life year (QALY). However, when they adjusted the stabilising effect of CXL to have a lifelong duration, the ICER decreased to €10,149/QALY. “That means the cost of one QALY is under the per capita GDP threshold and thus very cost-effective,” he said. Dr Godefrooij noted that the ability to maximise cost-effectiveness of CXL is limited by the difficulty in determining who will benefit most from CXL and who will benefit least. Not all keratoconus patients will require keratoplasty in their lifetime, and contact lenses may be all they will ever require. “A better defined indication for crosslinking would also improve cost-effectiveness,” he added. Daniel A Godefrooij: d.a.godefrooij@umcutrecht.nl