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10 - 12 February 2017, MECC Maastricht,The Netherlands.

This Meeting has been awarded 15 CME credits.

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

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Session Details

Session Title: Moderated Poster Session: Miscellaneous
Session Date/Time: Saturday 11/02/2017 | 13:00-14:15
Paper Time: 13:32
Venue: Poster Area


First Author: R. Simons THE NETHERLANDS
Co Author(s): M. Dickman  F. van den Biggelaar  C. Dirksen  R. Nuijts        

Abstract Details

Purpose:

To evaluate the cost-effectiveness of Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) as compared to DSAEK.

Setting:

Four tertiary medical centers in the Netherlands (Maastricht University Medical Center+, The Rotterdam Eye Hospital, University Medical Center Utrecht, University Medical Center Groningen).

Methods:

This cost-effectiveness analysis was conducted alongside a multicentre randomized controlled trial. Sixty-six eyes of 66 patients with Fuchs’ endothelial dystrophy were included in the economic evaluation and underwent UT-DSAEK (n=34) or DSAEK (n=32). The base case analysis was performed from a healthcare 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 quality-adjusted life year gained. Secondary analyses were performed using clinical improvement on the NEI VFQ-25 questionnaire (i.e., gain of ≥10 points), and clinical improvement in best-corrected visual acuity (BCVA) of ≥0.2 logMAR.

Results:

Average QALYs were lower in the UT-DSAEK group (0.70) than in the DSAEK group (0.72). Average costs were higher in the UT-DSAEK group (€6,036 vs. €5,911). Therefore, treatment with UT-DSAEK was dominated by treatment with DSAEK. In a secondary analysis, 59% and 53% of patients in the UT-DSAEK and DSAEK groups, respectively, showed clinical improvement on the NEI VFQ-25 questionnaire. The ICER was €2,097 per clinically improved patient. Similarly, 47% and 36% of patients showed clinical improvement in BCVA, resulting in an ICER of €1,086.

Conclusions:

UT-DSAEK was not cost-effective compared to DSAEK, based on the base case analysis using QALYs. When alternative measures for effectiveness were used, the ICERs were favourable for UT-DSAEK, indicating a high probability that UT-DSAEK was cost-effective compared to DSAEK. However, it is not known what society is willing to pay when alternative outcome measures are used.

Financial Disclosure:

None

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