Cost-effectiveness of treatments for dry eye syndrome
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Cost-Effectiveness of Topical Cyclosporine for Dry Eye Syndrome
Topical cyclosporine (0.05% emulsion) is a widely used treatment for moderate to severe dry eye syndrome, especially in patients unresponsive to conventional therapy. Studies show that cyclosporine provides a measurable improvement in quality of life, with a value gain of 0.0319 quality-adjusted life-years (QALY) per year and a 4.3% improvement in quality of life compared to lubricant therapy. The cost-utility ratio (CUR) for cyclosporine is $34,953 per QALY from a societal perspective and $37,179 per QALY from a third-party insurer perspective, indicating that it is a cost-effective option for patients with moderate to severe dry eye syndrome who do not respond to lubricants .
Cost-Effectiveness of Cryopreserved Amniotic Membrane vs. Cyclosporine
When comparing cryopreserved amniotic membrane plus topical medications to topical cyclosporine plus other medications, the amniotic membrane approach is generally less expensive and more effective over a one-year period from a societal perspective. The cost per utility for amniotic membrane is $18,275/0.78 compared to $20,740/0.74 for cyclosporine. Monte Carlo simulations show that amniotic membrane is the less costly and more effective option in 91.5% of cases, mainly due to improved patient productivity and fewer days lost from work. However, if only direct costs are considered, cyclosporine is less expensive ($4,112 vs. $10,300) .
Direct and Societal Costs of Dry Eye Treatments
Dry eye syndrome imposes a significant direct financial burden on healthcare systems. In a large Asian clinic, annual expenditures for dry eye treatments exceeded $1.5 million, with pharmacological treatments accounting for 99.2% of costs. Lubricant eye drops made up the majority of this expenditure. The true societal costs, including lost productivity and indirect costs, are likely much higher than direct healthcare costs alone .
Effectiveness and Value of Other Treatments
Autologous Blood Serum Eye Drops
Autologous blood serum eye drops are effective for severe dry eye syndrome, reducing conjunctivitis and corneal inflammation in 30–100% of cases. However, there is limited information on their cost-effectiveness compared to other treatments .
Punctal Plugs and Other Modalities
For patients with primary Sjögren’s syndrome, punctal plug insertion is highly effective, especially for those with aqueous deficiency. Steroid eye drops, diquafosol, carbomer gel, and lanolin ointment are also effective, with the choice of treatment depending on the presence of ocular surface inflammation. Cost-effectiveness data for these treatments are not detailed, but their clinical effectiveness is well supported .
Novel and Comprehensive Approaches
Emerging treatments, such as lysine-carbonized nanogels, show promise for longer-lasting relief with fewer doses compared to cyclosporine, potentially improving cost-effectiveness by reducing medication use and frequency . Comprehensive regimens combining hyaluronic acid, lipid-based drops, carbomer gel, and eyelid massage also yield significant clinical improvements, though cost data are not specified .
Artificial Tears and Lubricants
Artificial tears and lubricants, including trehalose-based solutions like Thealoz, are effective for mild to moderate dry eye and are widely used due to their low cost and safety profile 910. These treatments are often the first-line option and contribute significantly to overall treatment expenditures .
Conclusion
Topical cyclosporine is a cost-effective treatment for moderate to severe dry eye syndrome, especially when conventional lubricants fail. Cryopreserved amniotic membrane may offer even greater cost-effectiveness from a societal perspective, mainly due to improved productivity. Lubricant eye drops remain the mainstay of treatment and the largest contributor to direct costs. Other modalities, such as autologous serum, punctal plugs, and novel nanogel formulations, show clinical effectiveness, but more data are needed on their cost-effectiveness. Overall, the choice of treatment should consider both clinical effectiveness and the broader economic impact, including direct and indirect costs 12345679+1 MORE.
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