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

Research output: Contribution to journalArticleAcademicpeer-review


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 euro9431 (US$11 586) for UT-DSAEK and euro9110 (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 euro2500-euro80 000 (US$3071-US$98 280) per QALY. Additional analyses were performed omitting one UT-DSAEK patient who required a regraft [ICER euro9057 (US$11 127) per QALY, cost-effectiveness probability: 44-62%] and correcting QALYs for an imbalance in baseline utilities [ICER euro23 827 (US$29 271) per QALY, cost-effectiveness probability: 36-59%]. Furthermore, the ICER was euro2101 (US$2581) per patient with clinical improvement in best spectacle-corrected visual acuity (>= 0.2 logMAR) and euro3274 (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 languageEnglish
Pages (from-to)756-763
Number of pages8
JournalActa Ophthalmologica
Issue number8
Publication statusPublished - Dec 2019


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

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