Economic evaluation of endothelial keratoplasty techniques and penetrating keratoplasty in the Netherlands

Frank J H M van den Biggelaar, Yanny Y Y Cheng, Rudy M M A Nuijts, Jan S A G Schouten, Robert-Jan Wijdh, Elisabeth Pels, Hugo van Cleynenbreugel, Catharina A Eggink, Wilhelmina J Rijneveld, Carmen D Dirksen

Research output: Contribution to journalArticleResearchpeer-review


PURPOSE: To evaluate cost-effectiveness of penetrating keratoplasty (PK), femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK), and Descemet stripping automated endothelial keratoplasty (DSAEK).

DESIGN: Cost-effectiveness analysis based on data from a randomized multicenter clinical trial and a noncomparative prospective study.

METHODS: Data of 118 patients with corneal endothelial dysfunction were analyzed in the economic evaluation. Forty patients were included in the PK group, 36 in the FS-DSEK group, and 42 in the DSAEK group. The primary incremental cost-effectiveness ratio (ICER) was the incremental costs per clinically improved patient, defined as a patient with a combined effectiveness of both a clinically improved BSCVA (defined as an improvement of at least 2 lines) and a clinically acceptable refractive astigmatism (defined as less than or equal to 3.0 diopters). Analysis was based on a 1-year follow-up period after transplantation.

RESULTS: The percentage of treated patients who met the combined effectiveness measures was 52% for DSAEK, 44% for PK, and 43% for FS-DSEK. Mean total costs per patient were €6674 (US$7942), €12 443 (US$14 807), and €7072 (US$8416) in the PK group, FS-DSEK group, and DSAEK group, respectively. FS-DSEK was less effective and more costly compared to both DSAEK and PK. DSAEK was more costly but also more effective compared to PK, resulting in incremental costs of €4975 (US$5920) per additional clinically improved patient.

CONCLUSIONS: The results of this study show that FS-DSEK was not cost-effective compared to PK and DSAEK. DSAEK, on the other hand, was more costly but also more effective compared to PK. Including societal costs, a longer follow-up period and preparation of the lamellar transplant buttons in a national cornea bank could improve the cost-effectiveness of DSAEK.

Original languageEnglish
Pages (from-to)272-281.e2
JournalAmerican Journal of Ophthalmology
Issue number2
Publication statusPublished - Aug 2012


  • Aged
  • Astigmatism/physiopathology
  • Corneal Diseases/economics
  • Cost-Benefit Analysis
  • Descemet Stripping Endothelial Keratoplasty/economics
  • Female
  • Health Care Costs
  • Humans
  • Keratoplasty, Penetrating/economics
  • Laser Therapy/methods
  • Lasers, Excimer/therapeutic use
  • Male
  • Netherlands
  • Prospective Studies
  • Quality of Life
  • Sickness Impact Profile
  • Surveys and Questionnaires
  • Treatment Outcome
  • Visual Acuity/physiology


Dive into the research topics of 'Economic evaluation of endothelial keratoplasty techniques and penetrating keratoplasty in the Netherlands'. Together they form a unique fingerprint.

Cite this