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

Rob W P Simons; Mor M Dickman; Frank J H M van den Biggelaar; Carmen D Dirksen; Jeroen Van Rooij; Lies Remeijer; Allegonda Van der Lelij; Robert H J Wijdh; Pieter J Kruit; Rudy M M A Nuijts

doi:10.1111/aos.14126

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

Rob W P Simons, Mor M Dickman, Frank J H M van den Biggelaar, Carmen D Dirksen, Jeroen Van Rooij, Lies Remeijer, Allegonda Van der Lelij, Robert H J Wijdh, Pieter J Kruit, Rudy M M A Nuijts

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Abstract

PURPOSE: To evaluate the cost-effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus standard DSAEK.

METHODS: A cost-effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty-four eyes of 64 patients with Fuchs' endothelial dystrophy were included and randomized to UT-DSAEK (n = 33) or DSAEK (n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality-adjusted life years (QALYs) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY).

RESULTS: Societal costs were €9431 (US$11 586) for UT-DSAEK and €9110 (US$11 192) for DSAEK. Quality-adjusted life years (QALYs) were 0.74 in both groups. The ICER indicated inferiority of UT-DSAEK. The cost-effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from €2500-€80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER €9057 (US$11 127) per QALY, cost-effectiveness probability: 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER €23 827 (US$29 271) per QALY, cost-effectiveness probability: 36-59%]. Furthermore, the ICER was €2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (≥0.2 logMAR) and €3274 (US$4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire-25 composite score (≥10 points).

CONCLUSION: The base case analysis favoured DSAEK, since costs of UT-DSAEK were higher while QALYs were comparable. However, additional analyses revealed no preference for UT-DSAEK or DSAEK. Further cost-effectiveness studies are required to reduce uncertainty.

Original language	English
Pages (from-to)	756-763
Number of pages	8
Journal	Acta Ophthalmologica
Volume	97
Issue number	8
DOIs	https://doi.org/10.1111/aos.14126
Publication status	Published - Dec 2019

Keywords

Aged
Cost-Benefit Analysis
Descemet Stripping Endothelial Keratoplasty/economics
Female
Fuchs' Endothelial Dystrophy/economics
Health Care Costs/statistics & numerical data
Humans
Male
Netherlands
Ophthalmology/economics
Retrospective Studies
Visual Acuity

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10.1111/aos.14126Licence: CC BY-NC

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Simons, R. W. P., Dickman, M. M., van den Biggelaar, F. J. H. M., Dirksen, C. D., Van Rooij, J., Remeijer, L., Van der Lelij, A., Wijdh, R. H. J., Kruit, P. J., & Nuijts, R. M. M. A. (2019). Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK. Acta Ophthalmologica, 97(8), 756-763. https://doi.org/10.1111/aos.14126

@article{02df804f030c46938414fd9f59067630,

title = "Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK",

abstract = "PURPOSE: To evaluate the cost-effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus standard DSAEK.METHODS: A cost-effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty-four eyes of 64 patients with Fuchs' endothelial dystrophy were included and randomized to UT-DSAEK (n = 33) or DSAEK (n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality-adjusted life years (QALYs) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY).RESULTS: Societal costs were €9431 (US$11 586) for UT-DSAEK and €9110 (US$11 192) for DSAEK. Quality-adjusted life years (QALYs) were 0.74 in both groups. The ICER indicated inferiority of UT-DSAEK. The cost-effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from €2500-€80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER €9057 (US$11 127) per QALY, cost-effectiveness probability: 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER €23 827 (US$29 271) per QALY, cost-effectiveness probability: 36-59%]. Furthermore, the ICER was €2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (≥0.2 logMAR) and €3274 (US$4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire-25 composite score (≥10 points).CONCLUSION: The base case analysis favoured DSAEK, since costs of UT-DSAEK were higher while QALYs were comparable. However, additional analyses revealed no preference for UT-DSAEK or DSAEK. Further cost-effectiveness studies are required to reduce uncertainty.",

keywords = "Aged, Cost-Benefit Analysis, Descemet Stripping Endothelial Keratoplasty/economics, Female, Fuchs' Endothelial Dystrophy/economics, Health Care Costs/statistics & numerical data, Humans, Male, Netherlands, Ophthalmology/economics, Retrospective Studies, Visual Acuity",

author = "Simons, {Rob W P} and Dickman, {Mor M} and {van den Biggelaar}, {Frank J H M} and Dirksen, {Carmen D} and {Van Rooij}, Jeroen and Lies Remeijer and {Van der Lelij}, Allegonda and Wijdh, {Robert H J} and Kruit, {Pieter J} and Nuijts, {Rudy M M A}",

note = "{\textcopyright} 2019 The Authors. Acta Ophthalmologica published by John Wiley & Sons Ltd on behalf of Acta Ophthalmologica Scandinavica Foundation.",

year = "2019",

month = dec,

doi = "10.1111/aos.14126",

language = "English",

volume = "97",

pages = "756--763",

number = "8",

}

Simons, RWP, Dickman, MM, van den Biggelaar, FJHM, Dirksen, CD, Van Rooij, J , Remeijer, L, Van der Lelij, A, Wijdh, RHJ, Kruit, PJ & Nuijts, RMMA 2019, 'Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK', Acta Ophthalmologica, vol. 97, no. 8, pp. 756-763. https://doi.org/10.1111/aos.14126

TY - JOUR

T1 - Trial-based cost-effectiveness analysis of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus DSAEK

AU - Simons, Rob W P

AU - Dickman, Mor M

AU - van den Biggelaar, Frank J H M

AU - Dirksen, Carmen D

AU - Van Rooij, Jeroen

AU - Remeijer, Lies

AU - Van der Lelij, Allegonda

AU - Wijdh, Robert H J

AU - Kruit, Pieter J

AU - Nuijts, Rudy M M A

PY - 2019/12

Y1 - 2019/12

N2 - PURPOSE: To evaluate the cost-effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus standard DSAEK.METHODS: A cost-effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty-four eyes of 64 patients with Fuchs' endothelial dystrophy were included and randomized to UT-DSAEK (n = 33) or DSAEK (n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality-adjusted life years (QALYs) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY).RESULTS: Societal costs were €9431 (US$11 586) for UT-DSAEK and €9110 (US$11 192) for DSAEK. Quality-adjusted life years (QALYs) were 0.74 in both groups. The ICER indicated inferiority of UT-DSAEK. The cost-effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from €2500-€80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER €9057 (US$11 127) per QALY, cost-effectiveness probability: 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER €23 827 (US$29 271) per QALY, cost-effectiveness probability: 36-59%]. Furthermore, the ICER was €2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (≥0.2 logMAR) and €3274 (US$4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire-25 composite score (≥10 points).CONCLUSION: The base case analysis favoured DSAEK, since costs of UT-DSAEK were higher while QALYs were comparable. However, additional analyses revealed no preference for UT-DSAEK or DSAEK. Further cost-effectiveness studies are required to reduce uncertainty.

AB - PURPOSE: To evaluate the cost-effectiveness of ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) versus standard DSAEK.METHODS: A cost-effectiveness analysis using data from a multicentre randomized clinical trial was performed. The time horizon was 12 months postoperatively. Sixty-four eyes of 64 patients with Fuchs' endothelial dystrophy were included and randomized to UT-DSAEK (n = 33) or DSAEK (n = 31). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality-adjusted life years (QALYs) were determined using the Health Utilities Index Mark 3 questionnaire. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY).RESULTS: Societal costs were €9431 (US$11 586) for UT-DSAEK and €9110 (US$11 192) for DSAEK. Quality-adjusted life years (QALYs) were 0.74 in both groups. The ICER indicated inferiority of UT-DSAEK. The cost-effectiveness probability ranged from 37% to 42%, assuming the maximum acceptable ICER ranged from €2500-€80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER €9057 (US$11 127) per QALY, cost-effectiveness probability: 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER €23 827 (US$29 271) per QALY, cost-effectiveness probability: 36-59%]. Furthermore, the ICER was €2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (≥0.2 logMAR) and €3274 (US$4022) per patient with clinical improvement in National Eye Institute Visual Functioning Questionnaire-25 composite score (≥10 points).CONCLUSION: The base case analysis favoured DSAEK, since costs of UT-DSAEK were higher while QALYs were comparable. However, additional analyses revealed no preference for UT-DSAEK or DSAEK. Further cost-effectiveness studies are required to reduce uncertainty.

KW - Aged

KW - Cost-Benefit Analysis

KW - Descemet Stripping Endothelial Keratoplasty/economics

KW - Female

KW - Fuchs' Endothelial Dystrophy/economics

KW - Health Care Costs/statistics & numerical data

KW - Humans

KW - Male

KW - Netherlands

KW - Ophthalmology/economics

KW - Retrospective Studies

KW - Visual Acuity

U2 - 10.1111/aos.14126

DO - 10.1111/aos.14126

M3 - Article

C2 - 31025804

SN - 1755-375X

VL - 97

SP - 756

EP - 763

JO - Acta Ophthalmologica

JF - Acta Ophthalmologica

IS - 8

ER -

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

Abstract

Keywords

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