title: The lifetime economic burden of keratoconus: a decision analysis using a markov model.
abstract: OBJECTIVE
  To estimate the expected incremental lifetime cost of treatment of keratoconus compared to the expected cost of the treatment of myopia.
  
  
  METHODS
  Cost estimate from the patient's perspective using a Markov decision model.
  
  
  METHODS
  We modeled a hypothetical cohort of people with clinically significant incident keratoconus as defined by the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. We included costs of clinic visits, fitting fees, contact lenses, surgical procedures, and complications. Survival curves of corneal transplants and associated complications were modeled using data from the 2007 Australian Graft Registry. Medical treatment regimens after surgery were defined by expert opinion.
  
  
  RESULTS
  The expected value of the lifetime cost of the treatment of keratoconus over myopia was $25 168 with a standard deviation of $16 247 and a median of $17 596. The factors that most influenced the lifetime cost were the probability of initial corneal transplant and a subsequent regraft. The cost of routine care had relatively little influence on the lifetime cost of care.
  
  
  CONCLUSIONS
  The expected lifetime cost of treatment of keratoconus represents a significant cost to patients and payors. While the cost of routine care for keratoconus is not trivial, the primary factor influencing changes in the cost of care for keratoconus is the probability of corneal transplant. Combined with the significantly impaired vision-related quality of life and the relatively young onset of disease, the economic burden of the treatment of keratoconus represents a significant public health concern.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110-1093, USA.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Rebenitsch
authors.forename: Steven M
authors.initials: SM
authors.lastname: Kymes
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Walline
authors.forename: Mae O
authors.initials: MO
authors.lastname: Gordon
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007640:Keratoconus / Q000191:economics*; D015948:Keratoplasty, Penetrating / Q000191:economics; D008390:Markov Chains; D018803:Models, Economic; D009216:Myopia / Q000191:economics; D011336:Probability; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D014481:United States