A Cost-Minimization Analysis of Tissue-Engineered Constructs for Corneal Endothelial Transplantation

• Published in: PloS one Vol. 9; no. 6; p. e100563
• Main Authors: Tan, Tien-En, Peh, Gary S. L., George, Benjamin L., Cajucom-Uy, Howard Y., Dong, Di, Finkelstein, Eric A., Mehta, Jodhbir S.
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.06.2014; Public Library of Science (PLoS)
• Subjects: Aging; Biology and Life Sciences; Blindness; Blindness - economics; Blindness - pathology; Blindness - therapy; Construction costs; Construction engineering; Cornea; Cornea - pathology; Corneal Diseases - economics; Corneal Diseases - pathology; Corneal Diseases - therapy; Corneal transplantation; Corneal Transplantation - economics; Cost analysis; Cost engineering; Costs and Cost Analysis; Diabetes; Disease; Economics; Endothelium; Endothelium, Corneal - pathology; Endothelium, Corneal - transplantation; Engineering; Eye; Eye Banks; Eye surgery; Health services; Humans; Investment; Islet cells; Laboratories; Medicine and Health Sciences; Optimization; Pancreas; Patients; Pharmacology; Sensitivity; Sensitivity analysis; Social Sciences; Stem cells; Tissue analysis; Tissue Donors; Tissue engineering; Tissue Engineering - economics; Transplantation
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0100563

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.