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Cost minimization analysis of precut cornea grafts in Descemet’s stripping automated endothelial keratoplasty

Poster Details

First Author: K.Yong SINGAPORE

Co Author(s):    H. Nguyen   H. Cajucom-Uy   V. Foo   D. Tan   E. Finkelstein   J. Mehta     

Abstract Details

Purpose:

Descemet's stripping automated endothelial keratoplasty (DSAEK) has become the commonest corneal transplant procedure, however, there are variations in donor lamella cornea preparation practices. The aim of this study was to estimate and compare the costs of each of the three strategies for cornea preparation: 1) surgeon performing the cutting of cornea during surgery, 2) precutting cornea in a facility by trained technicians or 3) purchasing a cornea which is already precut from an eye bank. Surgery duration and surgical outcomes of the three strategies were also estimated and compared.

Setting:

Singapore National Eye Centre.

Methods:

This study included 110 subjects who received precut cornea and 140 who received surgeon-cut cornea. The main study outcome was cost of each strategy, which consisted of costs of setting up a facility and cost of surgical procedure. The fixed costs of precutting were obtained from Singapore Eye Bank. Recurring medical charges were compiled from billing data from Singapore National Eye Centre. The purchased precut corneas were obtained from an eye bank in Seattle. Key variables of the model were identified and varied to examine their effect on the overall outcome of the cost-minimization analysis.

Results:

There was significant time savings (p=0.001) of 13.1min for precut over surgeon-cut surgeries. The clinical outcomes between the 2 groups were not significantly different. The cost for DSAEK was highest for surgeon-cut approach, at $13,965 per transplant, while for purchasing precut cornea and precutting strategies were $12,659 and $12,421, respectively. The higher cost was due to longer duration of procedure. The cost savings for precutting strategy over surgeon cut strategy was $918,950 over 5 years, while for purchasing precut corneas was $118,340. The variable that has highest impact on cost is the number of cases performed in a facility

Conclusions:

The cost of cornea transplant and number of endothelial keratoplasties have been increasing yearly. There are many advantages for using precut cornea, including time and cost savings. Our findings suggest that it is more cost effective for centers that are performing a large number of cornea transplants to set up their own facility to conduct precutting

Financial Disclosure:

NONE

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