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Cost-effectiveness analysis of preloaded versus non-preloaded Descemet membrane endothelial keratoplasty for the treatment of Fuchs endothelial corneal dystrophy in an academic centre
  1. Myriam Böhm1,2,
  2. Pia Leon1,
  3. Adam Wylęgała1,
  4. Stephan Ong Tone1,
  5. Tracy Condron1,
  6. Ula Jurkunas1
  1. 1Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Ophthalmology, Goethe University Frankfurt, Frankfurt am Main, Germany
  1. Correspondence to Dr Ula Jurkunas, Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; Myriam.Boehm{at}gmail.com

Abstract

Aims To determine the cost-effectiveness of preloaded Descemet membrane endothelial keratoplasty (pDMEK) versus non-preloaded DMEK (n-pDMEK) for the treatment of Fuchs endothelial corneal dystrophy (FECD).

Methods From a societal and healthcare perspective, this retrospective cost-effectiveness analysis analysed a cohort of 58 patients with FECD receiving pDMEK (n=38) or n-pDMEK (n=30) from 2016 to 2018 in the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, USA. Exclusion criteria were previous ocular surgeries (other than uncomplicated cataract surgery), including other keratoplasty procedures, ocular pathological conditions as glaucoma, amblyopia, laser treatments, or any retinal or corneal disease. The main outcome parameters were the incremental cost-utility ratio (ICUR) and net monetary benefit (NMB).

Results pDMEK was less costly compared with n-pDMEK (healthcare: $13 886 vs $15 329; societal: $20 805 vs $22 262), with a slighter greater utility (QALY 0.6682 vs QALY 0.6640) over a time horizon of 15 years. pDMEK offered a slightly higher clinical effectiveness (+0.0042 QALY/patient) at a lower cost (healthcare: –$1444 per patient; societal: –$1457 per patient) in improving visual acuity in this cohort of patients with FECD. pDMEK achieved a favourable ICUR and NMB compared with n-pDMEK. Based on sensitivity analyses performed, the economic model was robust.

Conclusions From the societal and healthcare perspective, pDMEK was less costly and generated comparable utility values relative to n-pDMEK. Therefore, pDMEK appears to be cost-effective and cost saving with respect to n-pDMEK. Further long-term follow-up data are needed to confirm these findings.

  • cornea
  • dystrophy
  • eye (tissue) banking
  • treatment surgery
  • vision

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Footnotes

  • Contributors MB: design of the work, data collection, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published. PL: data collection, critical revision of the article, final approval of the version to be published. AW: data collection, critical revision of the article, final approval of the version to be published. SOT: data collection, critical revision of the article, final approval of the version to be published. TC: data collection, critical revision of the article, final approval of the version to be published. UJ: design of the work, data analysis and interpretation, drafting the article, critical revision of the article, final approval of the version to be published.

  • Funding This work was supported by European Society of Cataract and Refractive Surgeons (ESCRS) Peter Barry Fellowship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institutional review board approval was obtained from the Human Studies Committee of the MEEI. The study adhered to the tenets of the Declaration of Helsinki and was conducted in compliance with the rules and regulations of the Health Insurance Portability and Accountability Act.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The authors confirm that the data supporting the findings of this study are available within the article or its supplementary materials.

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