Cost-effectiveness analysis of preloaded descemet membrane endothelial keratoplasty versus non-preloaded descemet membrane endothelial keratoplasty
First Author: M.Boehm GERMANY
Co Author(s): P. Leon A. Wylegala S. Ong Tone U. Jurkunas
To determine the cost-effectiveness of preloaded Descemet membrane endothelial keratoplasty (pDMEK) versus non-preloaded DMEK (n-pDMEK) for the treatment of Fuchs endothelial corneal dystrophy (FECD).
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
The study was a cost-effectiveness analysis from a healthcare perspective using retrospective data of a cohort of patients with FECD. The analysis was conducted using 1-year cost and outcome data from 58 FECD patients, representing 38 pDMEK and 30 n-pDMEK cases, treated with endothelial keratoplasty at the Massachusetts Eye and Ear Infirmary from 2016 to 2018. The main outcome measures assessed were the incremental cost-utility ratio (ICUR) as measured in cost per quality-adjusted life-years (QALYs) gained associated with visual acuity outcomes and the net monetary benefit (NMB) assuming a willingness-to-pay (WTP) threshold of $100.000/QALY.
Performing a pDMEK instead of a n-pDMEK was found to be less costly ($10.082 vs. $11.059), with a slighter greater utility (QALY 1.2756 vs QALY 1.2739) over a time horizon of 15 years. The study shows that pDMEK offers a slightly higher clinical effectiveness (+0.0016 QALY/patient) at a lower cost (-$977/per patient) in improving visual acuity in this cohort of FECD patients. pDMEK achieves a favorable ICUR and NMB and thus dominates n-pDMEK.
From a healthcare perspective, pDMEK was less costly and generated slightly greater utility values compared to n-pDMEK. Therefore, pDMEK was the dominant and more cost-effective procedure with respect to n-pDMEK. Based on sensitivity analyses performed the economic model was robust.