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R. L. Rebenitsch, S. Kymes, J. Walline; The Lifetime Economic Burden of Keratoconus: A Markov Decision Model Analysis. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3525.
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The Collaborative Longitudinal Evaluation of Keratoconus (CLEK) study previously showed that people with keratoconus have a significantly impaired vision-related quality-of-life (V-QoL). Many people who suffer from this disease have partial or no insurance coverage for the treatment of their condition. The progression can also be variable. We aimed in this study to show the expected value of the lifetime cost of treatment of keratoconus over the expected cost of the treatment of myopia. We also aimed to show the potential range of costs a patient with keratoconus could incur.
We modeled a hypothetical cohort of people with clinically significant incident cases of keratoconus as defined by the CLEK study. We included costs of clinic visits, fitting fees, contact lenses, surgical procedures and complications. Survival curves of grafts and associated complications were modeled using data from the 2007 Australian Graft Registry. Medical treatment regimens after surgery were determined by collaboration with physicians at Washington University School of Medicine
The expected value of the lifetime cost of the treatment of keratoconus over myopia to a patient was $25,543 with a standard deviation of $19,396. The range of the costs was $6,341-$94,007. The average lifespan of a person in the model was 37.08 years with an average age of onset of 40.2 years.
The expected value of the lifetime cost of treatment of keratoconus represents a significant cost to a patient. Looking at the large range of the costs of treatment, we see that a patient could potentially afford the yearly cost of the treatment of keratoconus. However, as the cost increases, the patient would find the cost of treatment increasingly difficult to afford. Combined with the significantly impaired V-QoL previously shown to be associated with keratoconus, this economic burden of treatment of keratoconus represents a significant public health concern.
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