Cost utility analysis of cryopreserved amniotic membrane versus topical cyclosporine for the treatment of moderate to severe dry eye syndrome

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: < 68 days productivity lost; < $161 productivity lost/day; > 79% of amniotic membrane implants would need to be re-implanted at month 4 (for whatever reason); > $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; < 54% probability clinical improvement with amniotic membrane. Monte Carlo simulation demonstrated that amniotic membrane was the less costly, most effective alternative 91.5% of the time. Conclusion Based on improved outcomes using amniotic membrane, patient productivity was improved resulting in lower societal costs (less days lost from work). When considering the untoward effects of dry eye disease on societal costs, an improvement of the dry eye disease condition was accomplished most often with amniotic membrane.

Bio-Fabrication of Human Amniotic Membrane Zinc Oxide Nanoparticles and the Wet/Dry HAM Dressing Membrane for Wound Healing

“…(Cost of Dry Amniotic Membrane – Zabbys). The cost of amniotic membranes, on the other hand, ranged from $300 to 900 per device, putting a strain on patients who are paying out of pocket ( Gutiérrez-Moreno et al, 2011 ; Voigt and Anderson, 2019 : Voigt, 2020 ). Automation and large-scale HAM membrane preparation, as well as storage and transportation of the dressings, can all help to establish advanced technologies, improve the efficiency of membrane production, and reduce costs.…”

Bilateral Sutureless Application of Human Dehydrated Amniotic Membrane with a Specialised Bandage Contact Lens for Moderate-to-Severe Dry Eye Disease: A Prospective Study with 1-Month Follow-Up

“…54 The novel outpatient application of sutureless AM offers potential clinical service benefits, 19 and may be preferable to current standard treatments like cyclosporin due to better clinical outcomes and lower societal costs. 55 The methodology presented in this study, applicable in a primary care setting by trained eye care practitioners, such as optometrists, offers the potential for reduced treatment costs and improved patient outcomes, thereby alleviating the economic burden on public healthcare systems. 54,55 While this prospective pre-post study offers promising standardised results, it is limited by its short-term post-treatment assessment and the lack of a more rigorous randomised control group.…”

“…55 The methodology presented in this study, applicable in a primary care setting by trained eye care practitioners, such as optometrists, offers the potential for reduced treatment costs and improved patient outcomes, thereby alleviating the economic burden on public healthcare systems. 54,55 While this prospective pre-post study offers promising standardised results, it is limited by its short-term post-treatment assessment and the lack of a more rigorous randomised control group. Further research is necessary to explore the long-term benefits of the treatment in DED including in its impact on subclinical inflammation and corneal nerves.…”