Cost-utility analysis of cultured human corneal endothelial cells for corneal edema secondary to endothelial dysfunction: a Monte Carlo simulation model
Bibliographic record
Abstract
OBJECTIVE: This study aimed to evaluate the cost-effectiveness of injectable human corneal endothelial cell therapy, known as cultured human corneal endothelial cells (hCEC), compared to the current standard of Descemet stripping (automated) endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) for endothelial dysfunction using an economic simulation model. METHODS: In this Monte Carlo simulation cost-utility analysis, injectable hCEC therapy versus DSAEK/DMEK costs and effects were projected over a lifetime horizon for a simulated cohort of adult patients (≥18 years old), requiring endothelial keratoplasty in theoretical surgical centres in Ontario, Canada. Procedural wait times, effectiveness (quality-adjusted life year), and cost (2025 Canadian dollars) values were obtained from the literature and discounted at 3% per year. A cost-effectiveness threshold of incremental cost-effectiveness ratio ≤ $50,000 per quality-adjusted life year (QALY) gained was applied as a criterion for determining the economic viability of the interventions. RESULTS: The patient population consisted of 35,222 adults (estimated prevalence of endothelial dysfunction in Ontario). The preoperative wait time (days) was 102.99 (5.17) and 173.99 (5.54) for hCEC and DSAEK/DMEK, respectively. The life-time costs for hCEC and DSAEK/DMEK were $18,139.03 (SD 1,040.93) and $11,039.38 (SD 531.78), respectively. The expected lifetime QALYs were higher for those receiving hCEC (11.76; SD 2.74) relative to DSAEK/DMEK (9.16; SD 3.22). The incremental cost-effectiveness ratio for hCEC therapy against DSAEK/DMEK was $2,715.59 per QALY. The threshold analyses indicated that hCEC would be the dominant cost-effective option with a cost equal to or less than $10,000. CONCLUSIONS: Injectable hCEC therapy is a cost-effective option when compared to DSAEK/DMEK for endothelial dysfunction in this simulation model. The implementation of injectable hCEC therapy has the potential to improve clinical outcomes and increase accessibility for patients with endothelial dysfunction globally.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".