Cost utility analysis of DMEK vs DSAEK

Session Details

Session Title: Cornea Surgical I

Session Date/Time: Monday 12/09/2016 | 08:00-10:30

Paper Time: 09:32

Venue: Hall C1

First Author: : S.Cross USA

Co Author(s): :    S. Kacker                    

Abstract Details

Purpose:

To perform a cost utility analysis of DMEK (Descemets membrane endothelial keratoplasty) and DSAEK (Descemets automated endothelial keratoplasty) for endothelial dysfunction.

Setting:

This retrospective cost utility analysis was performed from a third party payer perspective using information gathered from three tertiary health care institutions (UAB, PH, Wilmer – JH) and four eye banks (Tissue bank international, Alabama Eye bank, Miracles in sight, Lions Sight) in the United States.

Methods:

A decision tree analysis was performed involving Markov modeling of two health care states (DMEK and DSAEK) with a time horizon of 10 years. Probabilities of complications in each state were calculated and weighted based on review of the published literature. Demographic characteristics of the cohort was also gathered from the published literature. This population was run through each state and outcomes were measured. Fees and charges associated with each procedure were obtained by examining the hospital bills of previous operative patients and also by reviewing physician reimbursement rates published by CMS.

Results:

Studies meeting inclusion criteria were included in the study analysis. In our model, DSAEK is less costly than DMEK, $4617.66 vs $5338.80 although the incremental cost effectiveness ratio (ICER) with a 10-year time horizon is $20, 227 when comparing DMEK with DSAEK. This confers cost effectiveness for DMEK against the $50,000 per capita GDP threshold. The average preoperative utility state was 0.27 (+/- 0.11). The probability of graft detachment was higher in the DMEK cohort. Graft rejection rates were higher in the DSAEK. Primary graft failure rates were greater in the DSAEK group. Findings from UT (ultra thin) DSAEK were included in the DSAEK cohort.

Conclusions:

Our analysis favors the transition from DSAEK to DMEK as the primary choice for Endothelial dystrophy from a cost utility perspective. Cost effectiveness is increased in both procedures with regards to their immediate predecessor; DSAEK versus PKP and DMEK versus DSAEK. To our knowledge, this is the first decision tree and Markov model performed for DSAEK and DMEK.

Financial Disclosure:

NONE