Cost-effectiveness of the ADVISE trial: An intraoperative OCT protocol in DMEK surgery

Casper van Der Zee*, Marc B. Muijzer, Frank J. H. M. van den Biggelaar, Rudy M. M. A. Nuijts, Heleen Delbeke, Mor. M. Dickman, Saskia M. Imhof, Robert P. L. Wisse

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

The intraoperative optical coherence tomography (iOCT) is recently introduced in Descemet membrane endothelial keratoplasty (DMEK) surgery, which aims to increase clinical performance and surgery safety. However, the acquisition of this modality is a substantial investment. The objective of this paper is to report on the cost-effectiveness of an iOCT-protocol in DMEK surgery with the Advanced Visualization in Corneal Surgery Evaluation (ADVISE) trial. This cost-effectiveness analysis uses data 6 months postoperatively from the multicentre prospective randomized clinical ADVISE trial. Sixty-five patients were randomized to usual care (n = 33) or the iOCT-protocol (n = 32). Quality-Adjusted Life Years (EQ-5D-5L), Vision-related Quality of Life (NEI-VFQ-25) and self-administered resources questionnaires were administered. Main outcome is the incremental cost-effectiveness ratio (ICER) and sensitivity analyses. The iOCT protocol reports no statistical difference in ICER. For the usual care group compared with the iOCT protocol, respectively, the mean societal costs are €5027 compared with €4920 (Δ€107). The sensitivity analyses report the highest variability on time variables. This economic evaluation learned that there is no added value in quality of life or cost-effectiveness in using the iOCT protocol in DMEK surgery. The variability of cost variables depends on the characteristics of an eye clinic. The added value of iOCT could gain incrementally by increasing surgical efficiency, and aiding in surgical decision-making.

Original languageEnglish
Pages (from-to)254-262
Number of pages9
JournalActa Ophthalmologica
Volume102
Issue number3
Early online dateJun 2023
DOIs
Publication statusPublished - May 2024

Keywords

  • corneal transplantation
  • cost-effectiveness
  • Descemet membrane endothelial keratoplasty
  • intraoperative OCT
  • quality-adjusted life years
  • vision-related quality of life
  • OPTICAL COHERENCE TOMOGRAPHY
  • MEMBRANE ENDOTHELIAL KERATOPLASTY
  • PENETRATING KERATOPLASTY
  • CORNEAL
  • TOOL

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