title: Cost effectiveness of collagen crosslinking for progressive keratoconus in the UK NHS.
abstract: BACKGROUND
  Keratoconus is a progressive degenerative corneal disorder of children and young adults that is traditionally managed by refractive error correction, with corneal transplantation reserved for the most severe cases. UVA collagen crosslinking is a novel procedure that aims to prevent disease progression, currently being considered for use in the UK NHS. We assess whether it might be a cost-effective alternative to standard management for patients with progressive keratoconus.
  
  
  METHODS
  We constructed a Markov model in which we estimated disease progression from prospective follow-up studies, derived costs derived from the NHS National Tariff, and calculated utilities from linear regression models of visual acuity in the better-seeing eye. We performed deterministic and probabilistic sensitivity analyses to assess the impact of possible variations in the model parameters.
  
  
  RESULTS
  Collagen crosslinking is cost effective compared with standard management at an incremental cost of £ 3174 per QALY in the base case. Deterministic sensitivity analysis shows that this could rise above £ 33,263 per QALY if the duration of treatment efficacy is limited to 5 years. Other model parameters are not decision significant. Collagen crosslinking is cost effective in 85% of simulations at a willingness-to-pay threshold of £ 30,000 per QALY.
  
  
  CONCLUSIONS
  UVA collagen crosslinking is very likely to be cost effective, compared with standard management, for the treatment of progressive keratoconus. However, further research to explore its efficacy beyond 5 years is desirable.
authors: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK.
authors: H A
authors: HA
authors: Salmon
authors: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK.
authors: D
authors: D
authors: Chalk
authors: NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK.
authors: K
authors: K
authors: Stein
authors: Department of Ophthalmology, South Devon Healthcare NHS Foundation Trust, Torquay, Devon, UK.
authors: N A
authors: NA
authors: Frost
mesh_terms: D000328:Adult; D003094:Collagen / Q000378:metabolism*; D003319:Corneal Stroma / Q000378:metabolism*; D003362:Cost-Benefit Analysis; D003432:Cross-Linking Reagents / Q000191:economics*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D007640:Keratoconus / Q000175:diagnosis / Q000191:economics* / Q000378:metabolism; D008390:Markov Chains; D009313:National Health Programs / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D014466:Ultraviolet Rays; D006113:United Kingdom; D055815:Young Adult
chemical_list: D003432:Cross-Linking Reagents; D003094:Collagen