Abstract
Objective
To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem
(PROSE; BostonSight, Needham Heights, Mass.) lens in patients with a distorted corneal
surface or ocular surface disease in Canada.
Design
Retrospective observational cohort study with cost, cost-utility, and benefit-cost
analyses.
Participants
Patients who received PROSE from the only PROSE clinic in Canada from 2018 to 2020.
Methods
Visual acuity (VA) outcomes of the participants were assessed. Benefits were defined
as VA improvements that were converted into utilities and then quality-adjusted life
years. Economic values were derived via government statements, clinic financial statements,
and published literature.
Results
Average best-corrected VA (BCVA) improvement was –0.42 ± 0.41 logMAR (p = 2.68 × 10–13) or Snellen 20/53 for the overall cohort, –0.51 ± 0.48 (p = 5.42 × 10–8) or Snellen 20/65 for distorted corneal surface patients, and –0.31 ± 0.30 (p = 1.30 × 10–7) or Snellen 20/41 for ocular surface disease patients. This corresponded to discounted
quality-adjusted life year gains of 0.51, 0.65, and 0.42, respectively, over an estimated
5-year PROSE device lifespan. Average cost to fit a patient with PROSE was USD$5 469.85
(CAD$7 087.28), of which USD$4 971.38 (CAD$6 441.42) was clinic cost and USD$498.47
(CAD$645.87) was patient cost. Cost-utility was USD$10 256.47 (CAD$13 289.31) for
the overall cohort, USD$8 439.79 (CAD$10 935.44) for distorted corneal surface patients,
and US$13 069.90 (CAD$16 934.67) for ocular surface disease patients. The benefit-cost
ratio was 34.4 for all, 43.8 for distorted corneal surface patients, and 28.3 for
ocular surface disease patients.
Conclusions
Our economic appraisal demonstrated that PROSE treatment provides a significant, cost-effective
benefit to Canadian patients with distorted corneal surfaces and ocular surface diseases.
This indicates that PROSE clinics are an efficient investment.
Résumé
Objectif
Réaliser une évaluation économique de la lentille PROSE (Prosthetic Replacement of Ocular Surface Ecosystem; BostonSight, Needham Heights, MA) chez des patients présentant une distorsion cornéenne
ou une maladie de la surface oculaire au Canada.
Nature
Étude d'observation de cohorte rétrospective comportant 3 analyses (coûts, coût-utilité
et coûts-avantages).
Participants
Patients qui ont reçu la lentille PROSE entre 2018 et 2020 à la seule clinique qui
offrait ces lentilles au Canada.
Méthodes
On a mesuré l'acuité visuelle (AV) des patients après l'utilisation de la lentille.
Les avantages ont été définis en fonction de l'amélioration de l'AV qui, à son tour,
a été convertie en utilité et ensuite en années de vie pondérées en fonction de la
qualité. Les valeurs économiques ont été tirées des déclarations gouvernementales,
des états financiers des cliniques et des articles publiés dans la littérature médicale.
Résultats
L'amélioration moyenne de la meilleure acuité visuelle corrigée (MAVC) se chiffrait
à–0,42 ± 0,41 logMAR (p = 2,68 × 10–13), soit 20/53 sur l’échelle Snellen, pour l'ensemble de la cohorte, à –0,51 ± 0,48
(p = 5,42 × 10–8), soit 20/65 sur l’échelle Snellen, pour les patients qui présentaient une distorsion
cornéenne et à –0,31 ± 0,30 (p = 1,30 × 10–7), soit 20/41 sur l’échelle Snellen, pour les patients qui présentaient une maladie
de la surface oculaire. Cette amélioration se traduisait par un gain actualisé par
année de vie pondérée en fonction de la qualité de 0,51, de 0,65 et de 0,42, respectivement,
sur la durée de vie fonctionnelle estimée de 5 ans de la lentille PROSE. Le coût moyen
par patient de l'ajustement d'une lentille PROSE était de 5 469,85 $US (7 087,28 $CAN),
dont 4 971,38 $US (6 441,42 $CAN) en coût pour la clinique et 498,47 $US (645,87 $CAN)
en coût pour le patient. Le coût-utilité se chiffrait à 10 256,47 $US (13 289,31 $CAN)
pour l'ensemble de la cohorte, à 8 439,79 $US (10 935,44 $CAN) pour la cohorte distorsion
cornéenne et à 13 069,90 $US (16 934,67 $CAN) pour la cohorte maladie de la surface
oculaire. Le rapport coûts-avantages s’élevait à 34,4 pour tous les patients, à 43,8
pour la cohorte distorsion cornéenne et à 28,3 pour la cohorte maladie de la surface
oculaire.
Conclusions
Notre évaluation économique a révélé que le traitement avec une lentille PROSE procure
des avantages significatifs et rentables pour les patients canadiens qui présentent
une distorsion cornéenne ou une maladie de la surface oculaire, ce qui permet d'affirmer
que les cliniques PROSE représentent un investissement efficace.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of OphthalmologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Clinical benefits of the Boston Ocular Surface Prosthesis.Am J Ophthalmol. 2010; 149 (54–61.e2)
- Assessment of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) scleral lens on visual acuity for corneal irregularity and ocular surface disease.Ocul Surf. 2018; 16: 254-258
- Quality of life and handling experience with the PROSE device: an Indian scenario.Clin Exp Optom. 2017; 100: 710-717
- PROSE for irregular corneas at a tertiary eye care center.Eye Contact Lens. 2014; 40: 71-73
- Use of Prosthetic Replacement of the Ocular Surface Ecosystem scleral lenses in patients with ocular chronic graft-versus-host disease.Biol Blood Marrow Transplant. 2015; 21: 2180-2184
- Boston ocular surface prosthesis: an Indian experience.Indian J. Ophthalmol. 2011; 59: 279-281
- Prosthetic replacement of the ocular surface ecosystem for corneal irregularity: visual improvement and optical device characteristics.Cont Lens Anterior Eye. 2019; 42: 526-532
- Economic appraisal of the Boston Ocular Surface Prosthesis.Am J Ophthalmol. 2009; 148 (860–8.e2)
- A Vision for Ontario: Strategic Recommendations for Ophthalmology in Ontario.Ministry of Health, TorontoMay 31, 2013
- Diagnoses and Outcomes of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment-A Canadian Experience.Eye Contact Lens. 2021; 47: 394-400
Bank of Canada. Annual exchange rates, https://www.bankofcanada.ca/rates/exchange/annual-average-exchange-rates/ (Accessed October 5, 2020).
Statistics Canada. Table 11-10-0239-01, Income of individuals by age group, sex and income source, Canada, provinces and selected census metropolitan areas. Ottawa, Ont., March 23, 2021, https://doi.org/10.25318/1110023901-eng.
Government of Canada. Automobile allowance rates, https://www.canada.ca/en/revenue-agency/services/tax/businesses/topics/payroll/benefits-allowances/automobile/automobile-motor-vehicle-allowances/automobile-allowance-rates.html (Accessed October 5, 2020).
Bank of Canada. Inflation calculator, https://www.bankofcanada.ca/rates/related/inflation-calculator/ (Accessed October 5, 2020).
US General Services Administration. Per diem rates, https://www.gsa.gov/travel/plan-book/per-diem-rates (Accessed October 5, 2020).
- Vision and quality-of-life.Trans Am Ophthalmol Soc. 1999; 97: 473-511
- The VF-14 index of visual function in recipients of a corneal graft: a 2-year follow-up study.Am J Ophthalmol. 2002; 134: 166-171
- Assessment of visual function after corneal transplantation: the Quality of Life and Psychometric Assessment after Corneal Transplantation (Q-PACT) Study.Am J Ophthalmol. 2003; 135: 785-793
- Age-related eye disease, quality of life, and functional activity.Arch Ophthalmol. 2005; 123: 807-814
- Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration.Arch Ophthalmol. 2002; 120: 481-484
- Incremental cost-utility analysis of deep anterior lamellar keratoplasty compared with penetrating keratoplasty for the treatment of keratoconus.Am J Ophthalmol. 2011; 152: 40-47
- Cost-effectiveness of Descemet's stripping endothelial keratoplasty versus penetrating keratoplasty.Ophthalmology. 2013; 120: 464-470
- Use of global visual acuity data in a time trade-off approach to calculate the cost utility of cataract surgery.Arch Ophthalmol. 2009; 127: 1183-1193
- Cost-effectiveness analysis in health and medicine.Oxford University Press, New York1966
US Department of Health and Human Services, Food and Drug Administration. Use of materials derived from cattle in human food and cosmetics. Fed Reg.216;81:14012–3.
Article info
Publication history
Published online: October 01, 2021
Accepted:
September 10,
2021
Received in revised form:
July 25,
2021
Received:
February 9,
2021
Identification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
