Cost-effectiveness of the Boston keratoprosthesis.
OBJECTIVE
To conduct a cost-utility analysis and determine the cost-effectiveness of the Boston Keratoprosthesis (Boston Kpro).


METHODS
Retrospective cohort study.


METHODS
setting: The Massachusetts Eye and Ear Infirmary corneal service. patients: Inclusion required a minimum 2-year follow-up. Patients with autoimmune diseases and chemical burns were excluded. Eighty-two patients were included with various indications for surgery. intervention: The keratoprosthesis is a collar button-shaped polymethylmethacrylate (PMMA) device consisting of 2 curved plates sandwiched around a corneal donor (allo)graft. The device is assembled intraoperatively and sutured to a patient's eye after removing the diseased cornea.


METHODS
Average cost-effectiveness of the keratoprosthesis was determined by cost-utility analysis, using expected-value calculations and time-tradeoff utilities. The comparative effectiveness, or gain in quality-adjusted life years (QALYs), was also sought. Cost-effectiveness was compared to recently published data on penetrating keratoplasty (PK).


RESULTS
A total discounted incremental QALY gain for the Boston Kpro of 0.763 correlated with a conferred QALY gain of 20.3% for the average patient. The average cost-effectiveness of the keratoprosthesis was $16 140 per QALY.


CONCLUSIONS
Comparable to corneal transplantation, with a cost-effectiveness between $12 000 and $16 000 per QALY, the keratoprosthesis can be considered highly cost-effective.
Ament
Jared D
JD
Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA 02114-4724, USA. jared_ament@meei.harvard.edu
Stryjewski
Tomasz P
TP
Ciolino
Joseph B
JB
Todani
Amit
A
Chodosh
James
J
Dohlman
Claes H
CH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001187:Artificial Organs / Q000191:economics*; D001672:Biocompatible Materials; D003315:Cornea; D003316:Corneal Diseases / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000191:economics; D019904:Polymethyl Methacrylate; D019736:Prostheses and Implants / Q000191:economics*; D019919:Prosthesis Implantation / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D055815:Young Adult
D001672:Biocompatible Materials; D019904:Polymethyl Methacrylate