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Randomized Controlled Trial
. 2019 Dec;97(8):756-763.
doi: 10.1111/aos.14126. Epub 2019 Apr 26.

Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK

Rob W P Simons  1 , Mor M Dickman  1 , Frank J H M van den Biggelaar  1 , Carmen D Dirksen  2 , Jeroen Van Rooij  3 , Lies Remeijer  3 , Allegonda Van der Lelij  4   5 , Robert H J Wijdh  6 , Pieter J Kruit  7 , Rudy M M A Nuijts  1
Affiliations
Randomized Controlled Trial

Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK

Rob W P Simons et al. Acta Ophthalmol. 2019 Dec.

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.

Keywords: Descemet stripping automated endothelial keratoplasty; Fuchs’ endothelial dystrophy; corneal transplantation; cost-effectiveness; costs; quality-adjusted life years; ultrathin Descemet stripping automated endothelial keratoplasty.

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Figures

Figure 1
Figure 1
Health‐related quality of life (utility) at baseline and 3, 6 and 12 months after DSAEK or UT‐DSAEK. DSAEK = Descemet stripping automated endothelial keratoplasty, UT‐DSAEK = ultrathin Descemet stripping automated endothelial keratoplasty.
Figure 2
Figure 2
Cost‐effectiveness plane showing the incremental costs from a societal perspective (y‐axis) and incremental QALYs (x‐axis) of treatment with UT‐DSAEK compared to DSAEK within a time horizon of 12 months postoperatively. Each data point represents one bootstrapped estimate of incremental costs and QALYs. DSAEK = Descemet stripping automated endothelial keratoplasty, QALY = quality‐adjusted life year, UT‐DSAEK = ultrathin Descemet stripping automated endothelial keratoplasty.
Figure 3
Figure 3
Cost‐effectiveness acceptability curve for the incremental costs per QALY gained (from a societal perspective) within a time horizon of 12 months after UT‐DSAEK compared to DSAEK. The graph shows the probabilities that UT‐DSAEK and DSAEK are cost‐effective for a range of maximum amounts of money health policymakers are willing to pay per QALY. The cost‐effectiveness probability of DSAEK equals 100% minus the cost‐effectiveness probability of UT‐DSAEK. DSAEK = Descemet stripping automated endothelial keratoplasty, QALY = quality‐adjusted life year, UT‐DSAEK = ultrathin Descemet stripping automated endothelial keratoplasty.
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