Cost-Effectiveness Analysis of Descemet's Membrane Endothelial Keratoplasty Versus Descemet's Stripping Endothelial Keratoplasty in the United States.
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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 OUTCOME MEASURES: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.
SUBMITTER: Gibbons A
PROVIDER: S-EPMC6606558 | biostudies-literature | 2019 Feb
REPOSITORIES: biostudies-literature
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