Medical costs of postoperative complications associated with endothelial keratoplasty from a healthcare perspective: preloaded Descemet membrane endothelial keratoplasty (pDMEK) vs non-preloaded Descemet membrane endothelial keratoplasty (n-pDMEK)
| Complications | Healthcare costs ($) | Societal costs ($) | pDMEK | n-pDMEK | P value |
| Incidence (%) | |||||
| Complications | |||||
| Intraocular pressure elevation* | 373.42 | 461.60 | 17.14% | 10.00% | 0.149 |
| Responding to topical treatment | 100.00% | 100.00% | – | ||
| Requiring surgery | – | – | – | ||
| Cystoid macular edema† | 471.67 | 603.94 | 0.00% | 3.33% | 0.257 |
| Responding to topical treatment | – | 100.00% | – | ||
| Requiring intravitreal triamcinolone | – | – | – | ||
| Secondary interventions | |||||
| Rebubbling‡ | 1110.72 | 2099.30 | 13.16% | 33.33% | 0.046* |
| Second rebubbling | 1110.72 | 2099.30 | 2.63% | 6.67% | 0.842 |
| Failed repositioning | 2.63% | 0.00% | 0.219 | ||
| Secondary keratoplasty | |||||
| Re-DMEK graft§ | 13 347.66 | 19 871.97 | 2.63% | 0.00% | 0.219 |
| Total healthcare costs ($) | 538.18 | 497.35 | |||
| Total societal costs ($) | 933.55 | 906.01 | |||
*Elevated intraocular pressure was managed medically in all cases. The costs of 1 bottle of generic timolol with average wholesale price (AWP) was $32.50 determined by LexiComp, glaucoma imaging of total $162.36 (visual field (CPT: 92083): $65.52; retinal nerve fibre layer OCT (CPT 92133): $38.52; optic nerve photo (CPT: 92250): $58.32) and two additional office visits were added during the global period. The cornea specialist worked in a multidisciplinary practice, thus postoperative management of glaucoma and cystoid macular edema did not lead to a charge of an additional office visit. The peripheral iridotomy was performed intraoperatively, thus costs were bundled with surgery fees.
†The cystoid macular edema (CME) resolved with topical medication like prednisolone acetate and keterolac (total $ 212.47 based on AWP). Additionally, three macula OCTs during three additional office visits were performed (CPT: 92143: $42.48) during the global period and one additional office visit including an OCT after the global period. All patients experienced resolution of their CME.
‡Rebubbling costs in the laser suite: rebubbling rates: pDMEK: 13.2%, n-pDMEK: 33.3%, rebubble Medicare reimbursement rate (CPT 66020): $192.24, medical supplies (needle, syringe, betadine, air filter, sterile gloves and mask, sterile drape): $ 17.40, two anterior segment OCTs (CPT 92132): $32.04; anaesthesia/PACU fees: $284.70, indirect labour costs: $ 417.30, Re-bubble fee in the OR: $135 (CPT 66020). Other indirect societal sector costs like patient time, caregiver time, transportation costs and productivity loss were based on previous calculations. The patient had an extra 5 days off of work and three additional clinic visits within the global period.
§Re-DMEK graft costs of preloaded DMEK were used for calculation.