title: A cost-minimization analysis of tissue-engineered constructs for corneal endothelial transplantation.
abstract: Corneal endothelial transplantation or endothelial keratoplasty has become the preferred choice of transplantation for patients with corneal blindness due to endothelial dysfunction. Currently, there is a worldwide shortage of transplantable tissue, and demand is expected to increase further with aging populations. Tissue-engineered alternatives are being developed, and are likely to be available soon. However, the cost of these constructs may impair their widespread use. A cost-minimization analysis comparing tissue-engineered constructs to donor tissue procured from eye banks for endothelial keratoplasty was performed. Both initial investment costs and recurring costs were considered in the analysis to arrive at a final tissue cost per transplant. The clinical outcomes of endothelial keratoplasty with tissue-engineered constructs and with donor tissue procured from eye banks were assumed to be equivalent. One-way and probabilistic sensitivity analyses were performed to simulate various possible scenarios, and to determine the robustness of the results. A tissue engineering strategy was cheaper in both investment cost and recurring cost. Tissue-engineered constructs for endothelial keratoplasty could be produced at a cost of US$880 per transplant. In contrast, utilizing donor tissue procured from eye banks for endothelial keratoplasty required US$3,710 per transplant. Sensitivity analyses performed further support the results of this cost-minimization analysis across a wide range of possible scenarios. The use of tissue-engineered constructs for endothelial keratoplasty could potentially increase the supply of transplantable tissue and bring the costs of corneal endothelial transplantation down, making this intervention accessible to a larger group of patients. Tissue-engineering strategies for corneal epithelial constructs or other tissue types, such as pancreatic islet cells, should also be subject to similar pharmacoeconomic analyses.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Singapore National Eye Centre, Singapore.
authors.forename: Tien-En
authors.initials: TE
authors.lastname: Tan
authors.affiliation: Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.
authors.forename: Gary S L
authors.initials: GS
authors.lastname: Peh
authors.affiliation: Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: George
authors.affiliation: Singapore Eye Bank, Singapore.
authors.forename: Howard Y
authors.initials: HY
authors.lastname: Cajucom-Uy
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Di
authors.initials: D
authors.lastname: Dong
authors.affiliation: Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore; Lien Centre for Palliative Care, Singapore.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Finkelstein
authors.affiliation: Singapore National Eye Centre, Singapore; Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.
authors.forename: Jodhbir S
authors.initials: JS
authors.lastname: Mehta
mesh_terms: D001766:Blindness / Q000191:economics* / Q000473:pathology / Q000628:therapy; D003315:Cornea / Q000473:pathology; D003316:Corneal Diseases / Q000191:economics* / Q000473:pathology / Q000628:therapy; D016039:Corneal Transplantation / Q000191:economics*; D003365:Costs and Cost Analysis; D004728:Endothelium, Corneal / Q000473:pathology / Q000637:transplantation; D005125:Eye Banks; D006801:Humans; D014019:Tissue Donors; D023822:Tissue Engineering / Q000191:economics