Comparative Cost-Effectiveness Analysis of Descemet Stripping Automated Endothelial Keratoplasty Versus Penetrating Keratoplasty in the United States

• Published in: American journal of ophthalmology 2013-01, Vol.155 (1), p.45-53.e1
• Main Authors: Prabhu, Shreya S, Kaakeh, Rola, Sugar, Alan, Smith, Dean G, Shtein, Roni M
• Format: Article
• Language: English
• Subjects: Corneal Diseases - economics; Corneal Diseases - surgery; Cost-Benefit Analysis; Decision Trees; Descemet Stripping Endothelial Keratoplasty - economics; Economics, Medical; Health Care Costs - statistics & numerical data; Health Services Research; Humans; Insurance, Health, Reimbursement - economics; Intraoperative Complications; Keratoplasty, Penetrating - economics; Models, Economic; Ophthalmology; Ophthalmology - economics; Postoperative Complications; Quality-Adjusted Life Years; Retrospective Studies; United States; Visual Acuity - physiology
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2012.06.014

Purpose To perform a comparative cost-effectiveness analysis of Descemet stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty (PK) for corneal endothelial disease. Design Retrospective cost-effectiveness analysis. Methods This cost-effectiveness analysis was performed from a third-party payer perspective with a 5-year time horizon. Probabilities of outcomes and complications of each of the procedures were calculated based on review of the published literature. A model was constructed to compare the costs and utilities associated with DSAEK and PK. Costs of donor tissue preparation, surgery, follow-up, postoperative complications, and procedures were considered. Utility values were based on quality-adjusted life years associated with visual acuity outcomes. Both costs and utilities were discounted at 3% per year. Sensitivity analyses were performed on key model inputs. Results Base case analysis found DSAEK to be less costly compared with PK ($9362 vs $10 239), with greater utility (3.15 vs 2.47 quality-adjusted life years). Sensitivity analyses revealed that even at graft failure rates for DSAEK approaching the rates for PK, DSAEK would still reduce costs. Varying the dislocation rate in our model showed that even at dislocation rates approaching 50%, DSAEK remained less costly. Further, with DSAEK rejection rates as high as 28%, DSAEK would remain a dominant procedure over PK. Conclusions Comparative cost-effectiveness analysis of DSAEK versus PK indicates favorable cost and utility outcomes associated with DSAEK for treatment of corneal endothelial disease. Longer follow-up of DSAEK outcomes will provide more accurate information regarding long-term cost-effectiveness of the procedure.