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The form of keratoconus in New Zealand has been shown to have a more rapid progression of disease. In this study, we aimed to evaluate the cost\u2010effectiveness of introducing screening for keratoconus in the New Zealand context, with corneal cross\u2010linking as treatment for those screening positive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov simulation was used to model the impact of screening plus corneal cross\u2010linking compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost\u2010effectiveness was determined by the incremental cost\u2010effectiveness ratio, with utility measured in quality\u2010adjusted life\u2010years. Univariate and probabilistic sensitivity analyses were carried out to investigate factors influencing cost\u2010effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incremental cost\u2010effectiveness for screening with corneal cross\u2010linking treatment was \u2010NZ$1278 (95% CI \u22121418, \u22121139) per QALY gained. Factors that had the most influence on incremental cost\u2010effectiveness were the specificity of the screening test, the prevalence of keratoconus at the time of screening, the discount rate, the probability of patients who are progressors, adherence, and efficacy of cross\u2010linking treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Screening for keratoconus at age 15 with corneal cross\u2010linking treatment for children who screened positive is likely to be cost saving. Our results support the need for a real\u2010world trial and cost\u2010effectiveness analysis in New Zealand to ensure that we identify and treat those at risk early in the disease course before significant vision loss has occurred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ceo.14604","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T05:57:56Z","timestamp":1757397476000},"page":"1125-1135","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Screening Plus Corneal Cross\u2010Linking for Keratoconus Is Cost\u2010Effective for New Zealand: A Proof\u2010of\u2010Concept Markov Analysis"],"prefix":"10.1111","volume":"53","author":[{"given":"Chuen Yen","family":"Hong","sequence":"first","affiliation":[{"name":"Health New Zealand Southern  Dunedin New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng 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