Trial-based cost-effectiveness analysis of Descemet's membrane endothelial keratoplasty (DMEK) vs ultrathin Descemet's stripping automated endothelial keratoplasty (UT-DSAEK)

Session Details

Session Title: Cornea Surgical: Lamellar Corneal Grafts

Session Date/Time: Tuesday 17/09/2019 | 08:30-10:30

Paper Time: 10:06

Venue: Free Paper Forum: Podium 3

First Author: : R.Simons THE NETHERLANDS

Co Author(s): :    S. Dunker   M. Dickman   F. van den Biggelaar   C. Dirksen   R. Nuijts                 

Abstract Details

Purpose:

To evaluate the cost-effectiveness of Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK).

Setting:

Six medical centers in the Netherlands (Maastricht University Medical Center+, University Medical Center Utrecht, University Medical Center Groningen, Deventer Medical Center, Radboud University Medical Center, Apeldoorn Medical Center).

Methods:

This economic evaluation was performed alongside a multicentre randomized controlled trial. Fifty-four eyes of 54 patients with Fuchs’ endothelial dystrophy were included in the economic evaluation and underwent DMEK (n=29) or UT-DSAEK (n=25). The base case analysis was performed from a societal perspective based on quality-adjusted life years (QALYs) within a time horizon of twelve months. The main outcome measure was the incremental cost-effectiveness ratio (ICER) per QALY gained. Secondary analyses were performed using clinical improvement on the NEI VFQ-25 questionnaire (gain of ≥10 points), and clinical improvement in best-corrected visual acuity (BCVA) of ≥0.2 logMAR.

Results:

Average QALYs were lower in DMEK patients (0.68 as determined by the HUI-3 questionnaire, 0.82 as determined by the EQ-5D-5L questionnaire) than in UT-DSAEK patients (HUI-3 0.78, EQ-5D-5L 0.85). Average costs were higher in the DMEK group (€8389 versus €8074). Therefore, treatment with DMEK was dominated by treatment with UT-DSAEK. In a secondary analysis, 62% and 67% of DMEK and UT-DSAEK patients, respectively, showed clinical improvement on the NEI VFQ-25 questionnaire. DMEK was again dominated by UT-DSAEK. In contrast, 59% and 29% of patients showed clinical improvement in BCVA, resulting in an ICER of €2,253 per clinically improved patient.

Conclusions:

Because DMEK was associated with lower QALYs and higher costs, the primary cost-effectiveness analysis favored UT-DSAEK over DMEK. Similarly, in a secondary analysis, fewer patients in the DMEK group demonstrated clinical improvement in vision-related quality of life (NEI VFQ-25). However, twice as many patients in the DMEK group demonstrated clinical improvement in BCVA of at least 0.2 logMAR compared to patients in the UT-DSAEK group. Using this effectiveness parameter in the cost-effectiveness analysis resulted in an ICER of €2253 per patient with clinical improvement.

Financial Disclosure:

None