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

摘要

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 ( QALY s) 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 ( QALY s) 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 QALY s 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 log MAR ) 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 QALY s were comparable. However, additional analyses revealed no preference for UT ‐ DSAEK or DSAEK . Further cost‐effectiveness studies are required to reduce uncertainty.