title: Economic evaluation of endothelial keratoplasty techniques and penetrating keratoplasty in the Netherlands.
abstract: OBJECTIVE
  To evaluate cost-effectiveness of penetrating keratoplasty (PK), femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK), and Descemet stripping automated endothelial keratoplasty (DSAEK).
  
  
  METHODS
  Cost-effectiveness analysis based on data from a randomized multicenter clinical trial and a noncomparative prospective study.
  
  
  METHODS
  Data of 118 patients with corneal endothelial dysfunction were analyzed in the economic evaluation. Forty patients were included in the PK group, 36 in the FS-DSEK group, and 42 in the DSAEK group. The primary incremental cost-effectiveness ratio (ICER) was the incremental costs per clinically improved patient, defined as a patient with a combined effectiveness of both a clinically improved BSCVA (defined as an improvement of at least 2 lines) and a clinically acceptable refractive astigmatism (defined as less than or equal to 3.0 diopters). Analysis was based on a 1-year follow-up period after transplantation.
  
  
  RESULTS
  The percentage of treated patients who met the combined effectiveness measures was 52% for DSAEK, 44% for PK, and 43% for FS-DSEK. Mean total costs per patient were €6674 (US$7942), €12 443 (US$14 807), and €7072 (US$8416) in the PK group, FS-DSEK group, and DSAEK group, respectively. FS-DSEK was less effective and more costly compared to both DSAEK and PK. DSAEK was more costly but also more effective compared to PK, resulting in incremental costs of €4975 (US$5920) per additional clinically improved patient.
  
  
  CONCLUSIONS
  The results of this study show that FS-DSEK was not cost-effective compared to PK and DSAEK. DSAEK, on the other hand, was more costly but also more effective compared to PK. Including societal costs, a longer follow-up period and preparation of the lamellar transplant buttons in a national cornea bank could improve the cost-effectiveness of DSAEK.
authors.affiliation: University Eye Clinic, 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 A G
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: Wilhelmina J
authors.initials: WJ
authors.lastname: Rijneveld
authors.forename: Carmen D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D000368:Aged; D001251:Astigmatism / Q000503:physiopathology; D003316:Corneal Diseases / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D057111:Descemet Stripping Endothelial Keratoplasty / Q000191:economics* / Q000379:methods; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015948:Keratoplasty, Penetrating / Q000191:economics*; D053685:Laser Therapy / Q000379:methods; D054018:Lasers, Excimer / Q000627:therapeutic use; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology