Authors' recommendations: Using CXL for the treatment of corneal thinning disorders is a relatively new innovation which has been approved for use in many countries. Surprisingly, no systematic reviews or meta-analyses have been completed on this topic, despite the availability of a number of cohort and RCT studies. Similarly, only two HTAs outline the economic implications of publically funding this technology, however, neither is relevant to the Alberta context. Although there is the risk of serious adverse events occurring after CXL treatment, these are rare. Post-procedure side-effects are frequent, but are either treatable or resolve with time. CXL is considered to be a safe, minimally invasive procedure. The meta-analysis in this report shows that CXL stabilizes the cornea. With keratoconus patients, CXL treatment was shown to produce statistically significant improvements in all outcomes considered except pachymetry. The studies reporting mixed disease groups showed less overall improvement in most measures but still demonstrated significant improvement in BCVA, UCVA, and pachymetry. Both of the included RCTs reported that CXL resulted in stabilization of corneal thinning. A budget impact analysis based on Alberta costs and global prevalence and incidence data found that provision of CXL would cost between $837,052.27 and $5,298,846.74 annually when existing cases are incorporated into the first three years and between $90,855.56 and $344,612.94 annually once existing cases have been treated and only new diagnosis' are undergoing CXL. This estimate is limited by a lack of Alberta prevalence and incidence rates for each disease. There are a number of gaps in the literature that limit this report. As of yet, long-term effects of CXL are not known. Since this technology is new, there is no outcome or safety data over a long follow-up time. Similarly, there is also no data on whether CXL will replace or delay the need for corneal transplant; this information would likely result from studies with long follow-up periods. There is also a lack of RCTs and high quality cohort studies. More RCT data would improve the quality of efficacy estimates. Overall, CXL appears to be effective and safe. However, the total cost, cost-effectiveness and long-term outcomes of the procedure are unknown.

Project Status: Completed

Year Published: 2012

URL for published report: https://wcm.ucalgary.ca/iph/system/files/cxl_corneal-crosss-linkage.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: HTA Unit, University of Calgary

Contact Address: 3rd Floor, TRW Building, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, Canada, T2N 4Z6

Contact Name: fclement@ucalgary.ca

Contact Email: fclement@ucalgary.ca

Copyright: University of Calgary