Cost-Effectiveness Analysis of Descemet's Membrane Endothelial Keratoplasty Versus Descemet's Stripping Endothelial Keratoplasty in the United States.
Ophthalmology
; 126(2): 207-213, 2019 02.
Article
in En
| MEDLINE
| ID: mdl-30273621
ABSTRACT
PURPOSE:
To determine the cost-effectiveness of Descemet's membrane endothelial keratoplasty (DMEK) compared with Descemet's stripping automated endothelial keratoplasty (DSAEK) in the United States.DESIGN:
Cost-effectiveness analysis in a surgical center in the United States.PARTICIPANTS:
Binocular adult patient undergoing endothelial keratoplasty.METHODS:
A base case of a 70-year-old man undergoing his first endothelial keratoplasty for bilateral Fuchs endothelial dystrophy. The cost-effectiveness of DMEK was compared with DSAEK over a 15-year time horizon. The incidences and costs of complications were derived from PubMed English literature searches, Medicare reimbursements, and average wholesale prices. All costs were discounted 3% per annum and adjusted for inflation to 2018 U.S. dollars. Uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. MAIN OUTCOMEMEASURES:
Incremental cost-effectiveness ratios and incremental cost-utility ratios, measured in cost per quality-adjusted life-years (QALYs).RESULTS:
Performing a DMEK instead of a DSAEK generated an extra 0.4 QALYs over a 15-year period. From a societal and third-party payer perspective, DMEK was cost-saving when compared with DSAEK in improving visual acuity in the base case. Probabilistic sensitivity analyses with variations in the costs and rebubble rates revealed that DMEK was cost-saving compared with DSAEK in 38% of iterations and was within a societal willingness-to-pay threshold of $50 000 in 98% of models.CONCLUSIONS:
From the societal and third-party payer perspectives in the United States, DMEK generated greater utilities and was less costly than DSAEK. Therefore, DMEK was the dominant procedure and was cost-saving with respect to DSAEK. The economic model was robust based on sensitivity analyses.
Full text:
1
Database:
MEDLINE
Main subject:
Endothelium, Corneal
/
Fuchs' Endothelial Dystrophy
/
Cost-Benefit Analysis
/
Descemet Membrane
/
Descemet Stripping Endothelial Keratoplasty
Type of study:
Health_economic_evaluation
/
Prognostic_studies
Limits:
Aged
/
Humans
/
Male
Country/Region as subject:
America do norte
Language:
En
Journal:
Ophthalmology
Year:
2019
Type:
Article