Cost Utility for Penetrating Keratoplasty in Patients with Poor Binocular Vision
Parts of this study were presented at: 23rd Congress of the European Society of Cataract and Refractive Surgeons, September 10–14, 2005, Lisbon, Portugal, and 15th European Society of Ophthalmology Congress and 103rd German Society of Ophthalmology, September 25–29, 2005, Berlin, Germany.
Received 17 December 2005; accepted 12 May 2006. published online 21 September 2006.
Purpose
Cost-utility and cost-effectiveness analyses are of increasing importance to clinicians and health policy experts. This study determines the costs in Germany and other countries in relation to gain of utility for patients with bilateral poor vision owing to corneal disease undergoing penetrating keratoplasty (PK) in 1 eye.
Design
A cost-utility analysis was performed using retrospective clinical data and high-level evidence-based data.
Participants
Sixty patients (mean age, 46.3 years) with bilateral poor vision who underwent PK for corneal disease.
Methods
Visual acuity and utility values were obtained before and 1 year after PK and after suture removal. A 10-year graft survival rate of 80% was assumed. Expenses included costs for the corneal transplant and surgery, medication, and optical rehabilitation. A discount rate of 5% was applied for costs and quality-adjusted life years (QALYs). Cost-utility analysis encompassed a 10-year period after surgery.
Main Outcome Measures
The number of QALYs was calculated for the study group undergoing PK. This was divided into the cost of the procedure to get the number of euros spent per QALY gained.
Results
Median binocular preoperative visual acuity was −log mean angle of resolution (−logMAR) 0.91±0.53 (Snellen equivalent 20/160) yielding a utility value of 0.67. After suture removal and optical rehabilitation, binocular visual acuity increased to median −logMAR 0.36±0.36 (20/46) with a utility value of 0.79. Over the 10 years after surgery and considering graft survival and discounting, a cost utility of €9551 per QALY was gained (equivalent to US$11 557). One-way sensitivity analysis yielded a range from €7706 to €12874 per QALY, highlighting the robustness of the model.
Conclusions
Although an expensive procedure, PK is cost effective in patients with bilateral poor vision.
1Department of Ophthalmology, Ludwig-Maximilians University, Muenchen, Germany.
2Remote Sensing Technology Institute, German Aerospace Center, Koeln, Germany.
Correspondence to Dr med Christoph Hirneiss, Augenklinik der Ludwig-Maximilians-Universität, Mathildenstr. 8, 80336 München, Germany.
Manuscript no. 2005-1230.
The authors have no commercial interest in any of the materials and methods used in this study.
ABSTRACT