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Ryan Ridges, Beth Beard, Deborah Jacobs; PROSE treatment for moderate to severe ocular graft-versus-host disease: Analysis of utilization rates versus projected demand across four centers. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4394. doi: https://doi.org/.
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Ocular graft-versus-host disease (oGVHD) is a debilitating complication in 30-40% of allogeneic hematopoetic stem cell transplants (allo-HSCT). While many oGVHD treatment modalities are available, oGVHD can remain undertreated because the diagnosing physicians, typically oncologists, may be unfamiliar with the range of treatments available while the treating physicians, often ophthalmologists, may be unfamiliar with the natural history and pathophysiology of the disease. This study investigates utilization rates vs. projected demand for prosthetic replacement of the ocular surface ecosystem (PROSE) treatment at four geographically distinct centers with various models for delivery of eye care.
PROSE is an effective treatment for moderate to severe oGVHD. Because BostonSight™ PROSE is available at a limited number of affiliated referral centers, its utilization rate can be conveniently tracked as an indicator of regional oGVHD detection and treatment patterns. Based on published estimates of oGVHD incidence and severity, we developed a formula to estimate the expected prevalence of moderate to severe oGVHD in allo-HSCT recipients as a function of annual transplant volume. This metric forecasts the annual incidence of moderate to severe oGVHD cases for which PROSE treatment is appropriate. For each of four PROSE centers, we compare the number of new PROSE patients treated in 2011 to the predicted number of new adult moderate/severe oGVHD cases generated by allo-HSCT done at all major transplant centers within 100 miles of the PROSE site. Factors contributing to the variation in utilization rate are considered.
Candidate oGVHD cases receiving PROSE treatment versus predicted demand, expressed as a percentage, were as follows: Site 1: 29.8%, Site 2: 13.1%, Site 3: 22.0%, Site 4: 64.7%. Site 4 is unique in that all allogeneic transplant recipients undergo ophthalmic evaluation prior to and at scheduled intervals after transplantation, whereas at other centers, ophthalmic consultation occurs on an as-needed basis.
There is wide variation in utilization of PROSE treatment in regions where it is available to allo-HSCT patients. Ophthalmic evaluation as part of allo-HSCT protocol is associated with higher utilization of a treatment proven to have high impact on visual function in patients with oGVHD.
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