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Economic appraisal of prosthetic replacement of ocular surface ecosystem in Canada

Published:October 01, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.09.004

      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.
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      References

        • Stason WB
        • Razavi M
        • Jacobs DS
        • et al.
        Clinical benefits of the Boston Ocular Surface Prosthesis.
        Am J Ophthalmol. 2010; 149 (54–61.e2)
        • Parra AS
        • Roth BM
        • Nguyen TM
        • Wang L
        • Pflugfelder SC
        • Al-Mohtaseb Z
        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
        • Bhattacharya P
        • Mahadevan R.
        Quality of life and handling experience with the PROSE device: an Indian scenario.
        Clin Exp Optom. 2017; 100: 710-717
        • Arumugam AO
        • Rajan R
        • Subramanian M
        • Mahadevan R.
        PROSE for irregular corneas at a tertiary eye care center.
        Eye Contact Lens. 2014; 40: 71-73
        • Theophanous C
        • Irvine JA
        • Parker P
        • Chiu GB.
        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
        • Rathi VM
        • Mandathara PS
        • Dumpati S
        • Vaddavalli PK
        • Sangwan VS.
        Boston ocular surface prosthesis: an Indian experience.
        Indian J. Ophthalmol. 2011; 59: 279-281
        • Kumar P
        • Mohamed A
        • Bhombal F
        • Dumpati S
        • Vaddavalli PK.
        Prosthetic replacement of the ocular surface ecosystem for corneal irregularity: visual improvement and optical device characteristics.
        Cont Lens Anterior Eye. 2019; 42: 526-532
        • Shepard DS
        • Razavi M
        • Stason WB
        • et al.
        Economic appraisal of the Boston Ocular Surface Prosthesis.
        Am J Ophthalmol. 2009; 148 (860–8.e2)
        • Provincial Vision Strategy Task Force
        A Vision for Ontario: Strategic Recommendations for Ophthalmology in Ontario.
        Ministry of Health, TorontoMay 31, 2013
        • Wong BM
        • Garg A
        • Trinh T
        • et al.
        Diagnoses and Outcomes of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment-A Canadian Experience.
        Eye Contact Lens. 2021; 47: 394-400
      1. Bank of Canada. Annual exchange rates, https://www.bankofcanada.ca/rates/exchange/annual-average-exchange-rates/ (Accessed October 5, 2020).

      2. 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.

      3. 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).

      4. Bank of Canada. Inflation calculator, https://www.bankofcanada.ca/rates/related/inflation-calculator/ (Accessed October 5, 2020).

      5. US General Services Administration. Per diem rates, https://www.gsa.gov/travel/plan-book/per-diem-rates (Accessed October 5, 2020).

        • Brown GC.
        Vision and quality-of-life.
        Trans Am Ophthalmol Soc. 1999; 97: 473-511
        • Boisjoly H
        • Gresset J
        • Charest M
        • et al.
        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
        • Mendes F
        • Schaumberg DA
        • Navon S
        • et al.
        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
        • Knudtson MD
        • Klein BE
        • Klein R
        • Cruickshanks KJ
        • Lee KE.
        Age-related eye disease, quality of life, and functional activity.
        Arch Ophthalmol. 2005; 123: 807-814
        • Brown MM
        • Brown GC
        • Sharma S
        • Landy J
        • Bakal J.
        Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration.
        Arch Ophthalmol. 2002; 120: 481-484
        • Koo TS
        • Finkelstein E
        • Tan D
        • Mehta JS.
        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
        • Bose S
        • Ang M
        • Mehta JS
        • Tan DT
        • Finkelstein E.
        Cost-effectiveness of Descemet's stripping endothelial keratoplasty versus penetrating keratoplasty.
        Ophthalmology. 2013; 120: 464-470
        • Lansingh VC
        • Carter MJ.
        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
        • Gold M
        • Siegel J
        • Russell L
        • Weinstein M
        Cost-effectiveness analysis in health and medicine.
        Oxford University Press, New York1966
      6. 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.