Economic appraisal of prosthetic replacement of ocular surface ecosystem in Canada
Authors: Anubhav Garg, Bryan M. Wong, Tanya Trinh, Michael Mimouni, Stephanie Ramdass, Jennifer Liao, Manokaraananthan Chandrakumar, Clara C. Chan, Allan R. Slomovic.
Disclosure Block: A. Garg: None. B.M.
Wong: None. T. Trinh: None. M. Mimouni: Any direct
financial payments including receipt of honoraria; Name of for-profit or
not-for-profit organization(s); Lapidot Medical, EyeYon Medical, The American
Physicians Fellowship for Medicine in Israel. Any direct financial payments
including receipt of honoraria; Description of relationship(s); Honoraria,
Honoraria, Fellowship Grant. S. Ramdass: Any direct financial payments
including receipt of honoraria; Name of for-profit or not-for-profit
organization(s); Bausch and Lomb, Synergeyes, Pentavision LLC. Any direct
financial payments including receipt of honoraria; Description of
relationship(s); Honoraria. J. Liao: Any direct financial payments
including receipt of honoraria; Name of for-profit or not-for-profit
organization(s); Santen Medical, Coopervision, BostonSight. Any direct
financial payments including receipt of honoraria; Description of relationship(s);
Honoraria. M. Chandrakumar: None. C.C. Chan: Any direct
financial payments including receipt of honoraria; Name of for-profit or
not-for-profit organization(s); Alcon, Allergan, Bausch and Lomb, Santen,
Shire, Tearlab, Johnson and Johnson, Zeiss. Any direct financial payments
including receipt of honoraria; Description of relationship(s); Honoraria. A.R.
Slomovic: Any direct financial payments including receipt of honoraria;
Name of for-profit or not-for-profit organization(s); Alcon, Novartis, Bausch
and Lomb, Santen, Shire, Acqueous. Any direct financial payments including
receipt of honoraria; Description of relationship(s); Consultant. Membership on
advisory boards or speakers’ bureaus; Name of for-profit or not-for-profit
organization(s); Allergan, Labtician/Thea. Membership on advisory boards or
speakers’ bureaus; Description of relationship(s); Advisory Board. Funded
grants or clinical trials; Name of for-profit or not-for-profit
organization(s); AMO. Funded grants or clinical trials; Description of
relationship(s); Research Assistance.
Abstract Title: Economic Appraisal of Prosthetic Replacement of Ocular Surface Ecosystem in Canada
Abstract Body:
Purpose: To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) lens in patients with distorted corneal surface or ocular surface disease in Canada.
Study Design: Retrospective observational cohort study with cost, cost utility, and benefit-cost analyses.
Methods: Visual acuity outcomes of 76 patients who received PROSE from the only PROSE clinic in Canada from 2018 to 2020 were assessed. Benefits were defined as improvements in visual acuity which were converted into utilities then quality-adjusted life years (QALYs). Economic values were derived via government statements, the clinic’s financial statements, and published literature.
Results: The PROSE device had favourable vision outcomes, as average BCVA improvement was -0.42±0.41 (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 the distorted corneal surface group, and -0.31±0.30 (p=1.30*10-7) or Snellen 20/41 for the ocular surface disease group. The distorted corneal surface group had a significantly larger BCVA improvement than the ocular surface disease group (p=0.04). This corresponded to discounted QALY gains of 0.51, 0.65, and 0.42, respectively, over an estimated 5-year PROSE device lifespan. A 5-year lifespan was estimated based on only one patient having documented discontinuation of PROSE over 277.6 ± 172.5 days of follow-up, a previous study, and clinician experience. The average cost to fit a patient with PROSE was $5,469.85USD ($7,087.28CAD), of which $4,971.38USD ($6,441.42CAD) was clinic cost and $498.47USD ($645.87CAD) was patient cost. The cost utility was favourable, at $10,256.47USD ($13,289.31CAD) per QALY gained for the overall cohort, $8,439.79USD ($10,935.44CAD) for the distorted corneal surface patients, and $13,069.90USD ($16,934.67CAD) for the ocular surface disease patients. Based on the U.S. Food and Drug Administration valuing a life-year at $369,000USD, the benefit-cost ratio was also favourable, at 34.4 for all patients, 43.8 for the distorted corneal surface group, and 28.3 for the ocular surface disease group.
Conclusions: Our economic appraisal demonstrated that PROSE treatment provided a significant, cost-effective benefit to patients with distorted corneal surfaces and ocular surface diseases. This indicates that PROSE clinics are an efficient investment of health care funding. This benefit was more pronounced than observed in a previous economic appraisal published in 2009 due to increased FDA valuation of a life, reduced device costs, and lower clinical service costs. A long-term prospective study in which VFQ-25 data is collected over several years is recommended to more accurately determine value provided by and the lifespan of a PROSE device.
