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

R.W.P. Simons*, S.L. Dunker, M.M. Dickman, R.M.M.A. Nuijts, F.J.H.M. van den Biggelaar, C.D. Dirksen, DMEK versus DSAEK Study Group

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Purpose To evaluate the cost-effectiveness of Descemet Membrane Endothelial Keratoplasy (DMEK) versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK). Methods A cost-effectiveness analysis using data from a multicenter randomized clinical trial was performed. The time horizon was 12 months postoperatively. Patients with Fuchs' endothelial dystrophy were randomized to DMEK (n = 29) or UT-DSAEK (n = 24). 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 (HUI3) and the EuroQol EQ-5D-5L questionnaires. The main outcome was the incremental cost-effectiveness ratio (ICER; incremental societal costs per QALY). Results Societal costs averaged euro8851 (US$11 406) for DMEK and euro8320 (US$10 722) for UT-DSAEK. Higher costs in the DMEK group were mainly caused by higher rebubbling and regraft rates (21% and 7%, vs. 4% and 0% in the UT-DSAEK group). HUI3 QALYs were 0.70 (DMEK) and 0.79 (UT-DSAEK). EQ-5D-5L QALYs were 0.83 (DMEK) and 0.86 (UT-DSAEK). The ICER indicated DMEK was dominated by UT-DSAEK in both analyses. The cost-effectiveness probability for DMEK ranged from 21% to 5% (HUI3 QALYs) and 27%-14% (EQ-5D-5L QALYs), assuming the maximum acceptable ICER ranged from euro2500 to euro80.000 (US$3222-US$103 093) per QALY. Conclusion The base case cost-effectiveness analysis favoured UT-DSAEK over DMEK, as costs of DMEK were higher while QALYs were lower. Further studies are required to assess long-term rebubbling and regraft rates and graft survival.
Original languageEnglish
Pages (from-to)319-329
Number of pages11
JournalActa Ophthalmologica
Issue number3
Early online date1 Oct 2022
Publication statusPublished - May 2023


  • corneal transplantation
  • cost-effectiveness
  • costs
  • DMEK
  • Fuchs' endothelial dystrophy
  • QALY

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