Cost-Effectiveness Comparison of DMEK and DSAEK
Ophthalmology, February 2019
Gibbons et al. studied the cost effectiveness of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) and found DMEK to offer superior cost effectiveness, with similar cost but greater utility.
The base case in this study was a 70-year-old man undergoing his first endothelial keratoplasty for bilateral Fuchs endothelial dystrophy. Costs were compared for a 15-year time horizon. The costs and incidences of complications were derived from Medicare reimbursement data, average wholesale prices, and PubMed literature in English. All costs were discounted 3% per annum and were adjusted for inflation to 2018 U.S. dollars. Uncertainty was assessed by deterministic and probabilistic sensitivity analyses. The primary outcomes were incremental cost-effectiveness ratios and incremental cost-utility ratios, measured in cost per quality-adjusted life-years (QALYs).
For the 15-year period, DMEK was superior to DSAEK with respect to QALYs, generating an extra 0.4 QALYs overall. DMEK also was more cost-effective for improving visual acuity, from the societal and third-party payer perspectives. Probabilistic sensitivity analyses, which included variations in costs and rebubble rates, showed that cost savings were greater with DMEK than DSAEK in 38% of iterations. Moreover, in 98% of the models, DMEK costs were within the societal willingness-to-pay threshold of $50,000/QALY.
Despite the favorable findings for DMEK, performing this procedure can be challenging because of the steep learning curve. The economic model in this study was designed for cases that were equally amenable to DMEK and DSAEK. However, the authors acknowledge that some patients are not suitable candidates for DMEK.
The original article can be found here.