TY - JOUR
T1 - Economic Evaluation of Deep Anterior Lamellar Keratoplasty Versus Penetrating Keratoplasty in The Netherlands
AU - van den Biggelaar, Frank J. H. M.
AU - Cheng, Yanny Y. Y.
AU - Nuijts, Rudy M. M. A.
AU - Schouten, Jan S. A. G.
AU - Wijdh, Robert-Jan
AU - Pels, Elisabeth
AU - Van Cleynenbreugel, Hugo
AU - Eggink, Catharina A.
AU - Zaal, Michel J. W.
AU - Rijneveld, Wilhelmina J.
AU - Dirksen, Carmen D.
PY - 2011/3
Y1 - 2011/3
N2 - PURPOSE: To evaluate the cost effectiveness of deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) in The Netherlands. DESIGN: Cost-effectiveness analysis alongside a randomized, multicenter clinical trial. METHODS: Fifty-three patients with corneal stromal pathologic features not affecting the endothelium were included with 28 patients in the DALK group and 25 in the PK group. Quality of life was measured before surgery and 3, 6, and 12 months after surgery. The main outcome measures were incremental cost-effectiveness ratios per clinically improved patient on the 25-item National Eye Institute Visual Functioning Questionnaire and per patient with endothelial cell loss of maximally 20% within the first year. RESULTS: Mean total bootstrapped costs per patient were (sic)7607 (US$10 498) in the DALK group and (sic)6552 (US$9042) in the PK group. The incremental cost-effectiveness ratios were (sic)9977 (US$13 768) per clinically improved patient on the 25-item National Eye Institute Visual Functioning Questionnaire and 6900 (US$9522) per patient with cell loss of maximally 20%. In patients without perforation of the Descemet membrane, the incremental cost-effectiveness ratio was (sic)5250 (US$7245) per patient. CONCLUSIONS: This study shows that DALK is more costly and more effective as compared with PK. Results on the 25-item National Eye Institute Visual Functioning Questionnaire were in favor of DALK, and endothelial cell loss in DALK patients remained stable after 6 months, whereas cell loss in PK patients continued. Furthermore, DALK procedures performed without perforation of the Descemet membrane were more effective. However, because it is unknown what society is willing to pay for an additional improved patient, cost effectiveness of DALK within a limited follow-up period of 12 months is unclear. Cost effectiveness of DALK may improve over time because of lower graft failure. (Am J Ophthalmol 2011;151:449-459.
AB - PURPOSE: To evaluate the cost effectiveness of deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) in The Netherlands. DESIGN: Cost-effectiveness analysis alongside a randomized, multicenter clinical trial. METHODS: Fifty-three patients with corneal stromal pathologic features not affecting the endothelium were included with 28 patients in the DALK group and 25 in the PK group. Quality of life was measured before surgery and 3, 6, and 12 months after surgery. The main outcome measures were incremental cost-effectiveness ratios per clinically improved patient on the 25-item National Eye Institute Visual Functioning Questionnaire and per patient with endothelial cell loss of maximally 20% within the first year. RESULTS: Mean total bootstrapped costs per patient were (sic)7607 (US$10 498) in the DALK group and (sic)6552 (US$9042) in the PK group. The incremental cost-effectiveness ratios were (sic)9977 (US$13 768) per clinically improved patient on the 25-item National Eye Institute Visual Functioning Questionnaire and 6900 (US$9522) per patient with cell loss of maximally 20%. In patients without perforation of the Descemet membrane, the incremental cost-effectiveness ratio was (sic)5250 (US$7245) per patient. CONCLUSIONS: This study shows that DALK is more costly and more effective as compared with PK. Results on the 25-item National Eye Institute Visual Functioning Questionnaire were in favor of DALK, and endothelial cell loss in DALK patients remained stable after 6 months, whereas cell loss in PK patients continued. Furthermore, DALK procedures performed without perforation of the Descemet membrane were more effective. However, because it is unknown what society is willing to pay for an additional improved patient, cost effectiveness of DALK within a limited follow-up period of 12 months is unclear. Cost effectiveness of DALK may improve over time because of lower graft failure. (Am J Ophthalmol 2011;151:449-459.
U2 - 10.1016/j.ajo.2010.09.012
DO - 10.1016/j.ajo.2010.09.012
M3 - Article
C2 - 21236411
SN - 0002-9394
VL - 151
SP - 449
EP - 459
JO - American Journal of Ophthalmology
JF - American Journal of Ophthalmology
IS - 3
ER -