Cost utility analysis of cryopreserved amniotic membrane versus topical cyclosporine for the treatment of moderate to se
- PDF / 3,025,842 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 60 Downloads / 193 Views
RESEARCH
Cost Effectiveness and Resource Allocation Open Access
Cost utility analysis of cryopreserved amniotic membrane versus topical cyclosporine for the treatment of moderate to severe dry eye syndrome Jeffrey Voigt*
Abstract Background: The purpose is to perform a cost effectiveness analysis amniotic membrane vs. topical medications in the use of treating dry eye disease. A cost effectiveness analysis comparing amniotic membrane + other topical medications to topical cyclosporine A + other topical medications was evaluated using accepted decision tree modeling software. Methods: TreeAge Pro 2019 software was used to evaluate the base case costs over a one year timeframe. Sensitivity analysis was performed on those variables which had the greatest effect on choosing one therapy versus the other based on cost. Monte Carlo simulation was run 1,000 times to determine the most effective, least costly alternative. Costs were evaluated from a societal level (direct + indirect). Quality of life utility scores were evaluated using known time tradeoffs from prior studies (scale 0–1; with 1 being perfect vision). Results: Over a one year timeframe, the base case demonstrated that amniotic membrane + topical medications was the less expensive alternative and provided for incremental utilities versus topical cyclosporine + other medications (Cost/utility: $18,275/0.78 vs. $20,740/0.74). If examining direct costs only, topical cyclosporine was the least expensive option over a one year timeframe: $4,112 vs. $10,300. Sensitivity analysis demonstrated that in order for topical cyclosporine to be the less expensive alternative the following variables would need to be: $2677 per amniotic membrane implant procedure (Medicare reimbursement rate); > 96% positive response to topical cyclosporine A at month 4; > 58% positive response to topical cyclosporine A at month 6 and; 96% positive response to topical cyclosporine at month 4; > 58% positive response to topical cyclosporine at month 6 and; 96% improvement at month 4 and a > 58% improvement at month 6 in order for cyclosporine A to be the less expensive option,
Voigt C ost Eff Resour Alloc
(2020) 18:56
Page 6 of 12
Fig. 2 Tornado Diagram studying the impact of individual parameters/variables, that had the greatest impact on costs
Table 2 Sensitivity analysis Variable
Base case used in model
Value at which cyclosporine A became the less expensive alternative
Figure
Productivity days lost
95 days
79%
Fig. 6
Cost for an AM surgical implantation
$1,445
> $2,677
Fig. 7
Probability of clinical improvement with AM
88%
96%
Fig. 9
Probability positive response Restasis month 6
24.5%
> 58%
Fig. 10
an unlikely event considering the modest improvement identified in the trial results [20]. Further, considering the reimbursement for an AM implant (CPT 65778—placement of amniotic membrane on the ocular surface without sutures) is $1445; its reimbursement would need to be 85% higher (i.e. $2677) in order for cyclosporine A to be the less expensive
Data Loading...
