title: Economic evaluation of deep anterior lamellar keratoplasty versus penetrating keratoplasty in The Netherlands.
abstract: OBJECTIVE
  To evaluate the cost effectiveness of deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK) in The Netherlands.
  
  
  METHODS
  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 €7607 (US$10,498) in the DALK group and €6552 (US$9042) in the PK group. The incremental cost-effectiveness ratios were €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 €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.
authors.affiliation: Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands. f.vanden.biggelaar@mumc.nl
authors.forename: Frank J H M
authors.initials: FJ
authors.lastname: van den Biggelaar
authors.forename: Yanny Y Y
authors.initials: YY
authors.lastname: Cheng
authors.forename: Rudy M M A
authors.initials: RM
authors.lastname: Nuijts
authors.forename: Jan S
authors.initials: JS
authors.lastname: Schouten
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: Wijdh
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pels
authors.forename: Hugo
authors.initials: H
authors.lastname: van Cleynenbreugel
authors.forename: Catharina A
authors.initials: CA
authors.lastname: Eggink
authors.forename: Michel J W
authors.initials: MJ
authors.lastname: Zaal
authors.forename: Wilhelmina J
authors.initials: WJ
authors.lastname: Rijneveld
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D000328:Adult; D003316:Corneal Diseases / Q000191:economics* / Q000601:surgery; D055954:Corneal Endothelial Cell Loss / Q000473:pathology; D016039:Corneal Transplantation / Q000191:economics* / Q000639:trends; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D015276:Health Care Rationing; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000191:economics* / Q000639:trends; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology