Cost effectiveness of locally made Descemet membrane endothelial keratoplasty grafts for corneal transplantation in Edmonton
First Author: M.Tong CANADA
Co Author(s): R. Birbal D. Ellis B. Kissick K. Kurji D. Mah D. Climenhaga
The purpose of this project was to create a sustainable, cost effective program where Descemet membrane endothelial keratoplasty (DMEK) grafts can be made and used locally, instead of purchased from American eye banks.
The Royal Alexandra Hospital in Edmonton, Alberta.
Two operators were trained to make DMEK grafts using the technique described by Lie et al. (2008). For DMEK grafts made between October 1, 2018 and December 31, 2019, donor corneas accepted as suitable for DMEK underwent slitlamp evaluation at the Comprehensive Tissue Centre (CTC). Unpaired T-test analysis (p < 0.05) was used to determine whether there was a significant difference between pre- and post-DMEK preparation ECD. The cost of each locally made graft was calculated and compared to the cost that would otherwise have been accrued if each graft had been bought from an American eye bank.
75 DMEK surgeries were done over 15 months. 29 (37%) of these were purchased from an American eye bank. 49 (63%) DMEK grafts were prepared locally, 3 (6%) of which failed the preparation process. Average donor age was 69 years, and 14 (29%) of donors had a diagnosis of diabetes mellitus. The average pre-DMEK ECD was 2852.8 (SD = 257.67; n = 49) and the average post-DMEK ECD was 2774.9 (SD = 293.44; n = 34), resulting in an average cell loss of 2.7% (p = 0.21). Average graft preparation time for operator 1 was 26 minutes (n = 29) and for operator 2 was 31 minutes (n = 20). The cost of making a DMEK graft locally was calculated based on initial purchase of re-sterilizable instruments ($2864.63 one-time investment), disposable instruments ($72.58 per graft), and additional transportation costs ($6.50 per graft). The cost of making 49 DMEK grafts locally was $6739.55. The cost of purchasing 29 DMEK grafts was $116 000. The cost of 78 DMEK grafts was $122 739.55, resulting in a savings of $189 260.45 over 15 months.
Training local operators to make high quality DMEK grafts with local donor corneas is extremely cost effective and an efficient use of local tissues.