Economic appraisal of prosthetic replacement of ocular surface ecosystem in Canada

Can J Ophthalmol. 2023 Apr;58(2):143-149. doi: 10.1016/j.jcjo.2021.09.004. Epub 2021 Oct 1.

Abstract

Objective: To perform an economic appraisal of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE; BostonSight, Needham Heights, Mass.) lens in patients with a distorted corneal surface or ocular surface disease in Canada.

Design: Retrospective observational cohort study with cost, cost-utility, and benefit-cost analyses.

Participants: Patients who received PROSE from the only PROSE clinic in Canada from 2018 to 2020.

Methods: Visual acuity (VA) outcomes of the participants were assessed. Benefits were defined as VA improvements that were converted into utilities and then quality-adjusted life years. Economic values were derived via government statements, clinic financial statements, and published literature.

Results: Average best-corrected VA (BCVA) improvement was -0.42 ± 0.41 logMAR (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 distorted corneal surface patients, and -0.31 ± 0.30 (p = 1.30 × 10-7) or Snellen 20/41 for ocular surface disease patients. This corresponded to discounted quality-adjusted life year gains of 0.51, 0.65, and 0.42, respectively, over an estimated 5-year PROSE device lifespan. Average cost to fit a patient with PROSE was USD$5 469.85 (CAD$7 087.28), of which USD$4 971.38 (CAD$6 441.42) was clinic cost and USD$498.47 (CAD$645.87) was patient cost. Cost-utility was USD$10 256.47 (CAD$13 289.31) for the overall cohort, USD$8 439.79 (CAD$10 935.44) for distorted corneal surface patients, and US$13 069.90 (CAD$16 934.67) for ocular surface disease patients. The benefit-cost ratio was 34.4 for all, 43.8 for distorted corneal surface patients, and 28.3 for ocular surface disease patients.

Conclusions: Our economic appraisal demonstrated that PROSE treatment provides a significant, cost-effective benefit to Canadian patients with distorted corneal surfaces and ocular surface diseases. This indicates that PROSE clinics are an efficient investment.

Publication types

  • Observational Study

MeSH terms

  • Canada
  • Corneal Diseases* / surgery
  • Ecosystem*
  • Humans
  • Retrospective Studies
  • Sclera
  • Visual Acuity