# A cross-over, randomised feasibility study of digitally-printed versus hand-painted artificial eyes in adults (PERSONAL-EYE-S): health economic findings

## TL;DR

This study tested whether it's feasible to collect health and cost data for a future large trial comparing hand-painted and digitally-printed artificial eyes in adults.

## Contribution

The study provides a framework for collecting health economic data to support a future full-scale RCT on artificial eyes.

## Key findings

- Health outcomes and resource use data were mostly feasible to collect, though resource use questionnaires needed refinement.
- Digitally-printed eyes had higher utility scores but required more remake appointments and had higher estimated costs.
- A full economic evaluation within a large RCT is considered feasible based on the findings.

## Abstract

Technology advances mean alternatives to hand-painted artificial eyes are possible, but the feasibility of conducting a large-scale trial is unknown. The aim was to assess the feasibility of collecting healthcare resource use and associated costs needed to undertake a large-scale randomised controlled trial (RCT) comparing the effectiveness and cost-effectiveness of hand-painted artificial eyes with digitally-printed artificial eyes.

Participants wore a digitally-printed artificial eye and a hand-painted artificial eye, for two weeks each, in a random order. Individual patient-level data was used to explore health outcomes (EQ-5D-5L) and resource use. Costs of the two artificial eye services were collected. A full economic evaluation was not conducted. An appropriate economic evaluation framework was developed to identify the relevant health economic data necessary for a future full trial.

Thirty-five participants were randomised. Response rates were 97–100% for the EQ-5D-5L. Resource use questions were less well completed: 54% complete responses at baseline, 40% partial responses and 6% missing/invalid responses. The two follow-up points had similar rates. Eye services cost data were well completed.

Mean utility was 0.77 after wearing the hand-painted eye and 0.83 after the digitally-printed eye. Average manufacturing times were 294 min (digitally-printed) and 355 min (hand-painted). Remake appointments were needed for digitally-printed eyes only. Estimated cost for the digitally-printed eye service is £404 and £347 for the hand-painted eye. Time between fitting and final evaluation was 56 days (digitally-printed eye) and 60 days (hand-painted). Results should be interpreted with caution, as estimates were based on a small sample.

It was possible to collect EQ-5D-5L, healthcare resource use and manufacturing times allowing a costing to be calculated. Thus, a large-scale RCT with full cost-effectiveness analysis would feasible. Refinements are suggested. Future economic analysis should consider how best to evaluate the service, possibility with modelling rather than within-trial analysis only.

ISRCTN85921622.

‒ Lack of research in this area meant there were uncertainties in the ability to collect economic data.

‒ Standardised measures and clinician data were well completed; however, work is needed to refine resource use questionnaire.

‒ A full economic evaluation within a full-scale randomised controlled trial exploring the effectiveness of different artificial eyes is feasible.