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

^*Corresponding author for this work

Department of Ophthalmology

Research output: Contribution to journal › Article › Academic › peer-review

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 - 1 Dec 2019

Keywords

corneal transplantation
cost-effectiveness
costs
Descemet stripping automated endothelial keratoplasty
Fuchs’ endothelial dystrophy
quality-adjusted life years
ultrathin Descemet stripping automated endothelial keratoplasty

Access to Document

10.1111/aos.14126

Simons_et_al-2019-Acta_OphthalmologicaFinal published version, 303 KB

Cite this

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{d09ed78819784a728eeb80a3f12064ce,

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{\textquoteright} 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 = "corneal transplantation, cost-effectiveness, costs, Descemet stripping automated endothelial keratoplasty, Fuchs{\textquoteright} endothelial dystrophy, quality-adjusted life years, ultrathin Descemet stripping automated endothelial keratoplasty",

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.}",

year = "2019",

month = dec,

day = "1",

doi = "10.1111/aos.14126",

language = "English",

volume = "97",

pages = "756--763",

journal = "Acta Ophthalmologica",

issn = "1755-375X",

publisher = "Wiley-Blackwell",

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 - 2019/12/1

Y1 - 2019/12/1

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 - corneal transplantation

KW - cost-effectiveness

KW - costs

KW - Descemet stripping automated endothelial keratoplasty

KW - Fuchs’ endothelial dystrophy

KW - quality-adjusted life years

KW - ultrathin Descemet stripping automated endothelial keratoplasty

UR - http://www.scopus.com/inward/record.url?scp=85065047750&partnerID=8YFLogxK

U2 - 10.1111/aos.14126

DO - 10.1111/aos.14126

M3 - Article

C2 - 31025804

AN - SCOPUS:85065047750

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

Access to Document

Other files and links

Fingerprint

Cite this