Cost-Effectiveness of Corneal Collagen Crosslinking for Progressive Keratoconus: A Brazilian Unified Health System Perspective

Lucca Ortolan Hansen (), Renato Garcia, André Augusto Miranda Torricelli and Samir Jacob Bechara
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Lucca Ortolan Hansen: Division of Ophthalmology, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
Renato Garcia: Division of Ophthalmology, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
André Augusto Miranda Torricelli: Division of Ophthalmology, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil
Samir Jacob Bechara: Division of Ophthalmology, School of Medicine, University of São Paulo, São Paulo 01246-903, SP, Brazil

IJERPH, 2024, vol. 21, issue 12, 1-10

Abstract: Keratoconus is a burden to health systems and patients worldwide. Corneal collagen crosslinking (CXL) treatment has been shown abroad to be cost-effective for treating progressive keratoconus. However, no cost-effectiveness studies have been performed in Brazil. The aim of this study was to assess the cost-effectiveness of corneal collagen crosslinking (CXL) compared with the conventional treatment for progressive keratoconus from the Brazilian Unified Health System (SUS) payer’s perspective. A lifetime microsimulation model was utilized to compare the lifetime costs and quality-adjusted life years for patients undergoing corneal collagen CXL or conventional treatment. Two groups of 5000 18-year-old patients were simulated, with one group receiving corneal CXL at the outset and the control group remaining untreated. The TreeAge Pro Healthcare 2024 software was used for modeling and analysis. Corneal collagen CXL demonstrated superior cost-effectiveness compared to the conventional treatment, with an incremental cost-effectiveness ratio of 58.26 USD/quality-adjusted life years (QALY) gained (95% CI: 58.17–58.36) and a positive incremental net monetary benefit of USD 11,613.82 (95% CI: 11,605.66–11,621.99). CXL significantly reduced the number of required corneal transplants, with a mean of 968.8 (95% CI: 959–978.58) fewer transplants per 10,000 eyes treated. The variable with the most significant impact on the incremental net monetary benefit was the duration of the CXL effect. This study concluded that corneal CXL is a highly cost-effective intervention for progressive keratoconus within the Brazilian SUS. These findings advocate for broader accessibility to this vision-saving treatment within the SUS.

Keywords: keratoconus; cost-effectiveness; incremental cost-effectiveness ratio; incremental net monetary benefit; keratoconus; corneal crosslinking; quality-adjusted life years; SUS; Brazilian Unified Health System (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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