Abstract
Purpose :
Corneal blindness leads to severe decrease in life quality, including higher general mortality and associated lost productivity. Transplantation of donated corneal tissue is the only current treatment, which is limited by the lack of donors. Tissue engineering has potential to produce transplantable corneal tissue. We aimed to assess the cost-effectiveness of engineered corneal endothelium in comparison with the current treatment and a quality-adjusted life year analysis (QALY) in Mexican population using a Markov model.
Methods :
For the analysis we built a Markov model. We assume there are 3 health states: blind, see, or dead. They could transition between the blindness and see transition and between these states and death. Calling this last “the absorbing state”. The state blind was considered the initial state. We assumed individuals have a transplant that restores vision which may or not work. We assumed the harvested cells from a donor cornea can be used to produce 10x more corneal transplants. We took a hypothetical cohort of 1000 blind patients aged 35 years and ran the Markov model for 40 years to reach life expectancy. The discount rate for the calculations was 3.5% and considered for 10 years. We assumed that the harvesting process and final operation cost per patient would be the same. With more transplants available we assumed the intervention will decrease waiting list from 3 to 1 year. We considered a 2020 gross domestic product (GDP) per capita in Mexico of 8,346.70 USD. We compared the price for QALY per gained with the GDP per capita in Mexico. The survival rate/duration of the transplant was 87% for 1y, 72% for 3y, 54% for 6y and 42% for 10y
Results :
The QALY gained was 0.074 and 0.74 for corneal endothelium transplant and engineered corneal endothelium, respectively. Considering that the scale of QALY value ranges from 0 (death) to 1 (perfect health), the engineered corneal endothelia will considerably benefit the Mexican population.
Conclusions :
The intervention of engineered corneal endothelium the Mexican population will be cost-effective. These assumptions would be transferable to other Latin-American countries. Further cost-utility analysis will provide more detailed results.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.