Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK.
Acta Ophthalmol
; 97(8): 756-763, 2019 Dec.
Article
en En
| MEDLINE
| ID: mdl-31025804
ABSTRACT
PURPOSE:
To evaluate the cost-effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus standard DSAEK.METHODS:
A cost-effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty-four eyes of 64 patients with Fuchs' endothelial dystrophy were included and randomized to UT-DSAEK (n = 33) or DSAEK (n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality-adjusted life years (QALYs) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY).RESULTS:
Societal costs were 9431 (US$11 586) for UT-DSAEK and 9110 (US$11 192) for DSAEK. Quality-adjusted life years (QALYs) were 0.74 in both groups. The ICER indicated inferiority of UT-DSAEK. The cost-effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from 2500-80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER 9057 (US$11 127) per QALY, cost-effectiveness probability 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER 23 827 (US$29 271) per QALY, cost-effectiveness probability 36-59%]. Furthermore, the ICER was 2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (≥0.2 logMAR) and 3274 (US$4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire-25 composite score (≥10 points).CONCLUSION:
The base case analysis favoured DSAEK, since costs of UT-DSAEK were higher while QALYs were comparable. However, additional analyses revealed no preference for UT-DSAEK or DSAEK. Further cost-effectiveness studies are required to reduce uncertainty.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_financiamento_saude
Asunto principal:
Oftalmología
/
Agudeza Visual
/
Distrofia Endotelial de Fuchs
/
Costos de la Atención en Salud
/
Queratoplastia Endotelial de la Lámina Limitante Posterior
Tipo de estudio:
Health_economic_evaluation
/
Observational_studies
Aspecto:
Patient_preference
Límite:
Aged
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
Acta Ophthalmol
Asunto de la revista:
OFTALMOLOGIA
Año:
2019
Tipo del documento:
Article
País de afiliación:
Países Bajos