Benefits of ocular surface prosthesis outweigh costs by factor of four

Am J Ophthalmol. 2009;148(6):860-868.

An ocular surface implant proved cost-effective and significantly improved quality-of-life in patients with corneal ectasia, irregular astigmatism or ocular surface disease, according to a study.

The prospective, observational study included 69 patients with a mean age of 44 years who received the Boston Ocular Surface Prosthesis and completed baseline and 6-month follow-up assessments. Snellen visual acuity scores were converted to logMAR values. The National Eye Institute's Visual Functioning Questionnaire (VFQ-25) was used to assess visual function at baseline and 6 months after implantation.

Benefits, based on improved VFQ-25 scores, were converted to quality-adjusted life years (QALYs). Economic values and costs were obtained from published studies and financial statements. Benefits were discounted 3% per year, the standard recommended rate. The Boston Ocular Surface Prosthesis offers full benefits for an average of 5 years, the study authors said.

Study data showed that mean VFQ-25 scores increased from 57 to 77.8. The increase was statistically significant (P < .001). Mean quality-of-life improved by 0.10 QALYs per year. Based on the 3% annual discount and 5-year lifetime of the implant, the average lifetime gain was 0.48 QALYs.

The average benefit-cost ratio was 4 to 1. In patients with the lowest average baseline VFQ-25 scores, the benefit-cost ratio was 5.6 to 1.

"Further studies will be required to compare [the prosthesis] with alternative treatment options such as corneal transplantation in patients with advanced keratoconus or tarsorrhaphy in patients with severe ocular surface disease," the authors said.