Two of the variables were positively related to the cost advantage ; as these variables increased, the cost advantage of the tissue engineering strategy increased. The other five variables were inversely related to the cost advantage. In terms of the magnitude of effect, it was found that the largest determinant of the cost advantage was the cost of each donor cornea. This was followed by the cost of the plastic compressed collagen carrier, and by the culture yield from each pair of corneas. In probabilistic sensitivity analyses, all seven variables were varied simultaneously across 10,000 simulations. The tissue engineering strategy produced transplantable tissue at a lower cost than the procured-tissue strategy in 100% of simulations. As an additional form of sensitivity analysis, two AZD6244 specific alternative scenarios were tested. The technique of cultivating HCECs from one donor ex vivo and transplanting them on a carrier to treat endothelial disease in the recipient was conceptualized over 30 years ago. Since then, however, efforts to translate this into clinical practice have been hampered by difficulty in culturing HCECs and the lack of effective surgical techniques to transplant them. Recently though, greater understanding in the cell biology of HCECs has led to the establishment of reliable HCEC culture protocols. HCECs can now be consistently expanded up to the third passage, while retaining their unique cellular morphology and the expression of characteristic markers indicative of the corneal Fingolimod endothelium. Suitable carriers for these cultured HCECs have also been successfully tested. Finally, the advent and success of EK techniques like DSEK/DMEK enables the effective surgical delivery of these constructs. Such recent advances may have made tissue-engineered endothelial constructs a realistic prospect, but can they be produced at a competitive cost? The results of this cost-minimization analysis indicate that tissue engineering can produce transplantable corneal endothelial tissue at a fraction of current costs. Both investment costs and recurring costs were lower for tissue-engineered constructs compared to tissue procured from eye banks.