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Cost‐effectiveness of the Boston keratoprosthesis
Author(s) -
AMENT JD,
STRYJEWSKI TP,
DOHLMAN CH
Publication year - 2009
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2009.2175.x
Subject(s) - medicine , visual acuity , retrospective cohort study , cohort , surgery , keratoprosthesis , cost effectiveness , univariate analysis , quality adjusted life year , ophthalmology , multivariate analysis , risk analysis (engineering)
Purpose Blindness due to corneal disease accounts for approximately 8 million of the 37 million blind in the world. A 2007 study confirmed the global cost‐effectiveness (CE) of cataract surgery and penetrating keratoplasty (PK). We sought to determine the CE of the Boston Keratoprosthesis. Methods In a retrospective chart review, patients who underwent KPro type I surgery in the United States over the last 5 years were identified. Patients had to have a minimum of 2 years of visual acuity follow‐up data. Patients with autoimmune diseases and chemical burns were excluded. Eighty‐three patients were included. CE was determined by cost‐utility analysis (CUA). Complications and additional procedures were incorporated into a weighted cost decision tree. A conservative retention estimate of 85% was assumed at 5 years. Visual acuity values were converted to utilities and determined to be normally distributed per Shapiro‐Wilk testing. Results The mean preoperative utility value was 0.449 increasing to 0.630 postoperatively. The mean incremental utility was 0.182. Amongst our cohort, 65 patients experienced improvement in their BSCVA at 2 years, 13 experienced no improvement, and 5 deteriorated. A total discounted incremental QALY gain of 0.763 was obtained. The total discounted cost associated with this utility equaled $11250 (USD). The cost‐utility of the KPro was $13106 per QALY. The model was assessed using both univariate and multivariate sensitivity analyses. Conclusion The KPro is becoming an established procedure in the US for complex ophthalmic patients, often with numerous comorbidities. The cost effectiveness of KPro was determined in this study to be $13106 USD per QALY. This is comparable to PK, which has been reported in the range of $12000‐16000 USD per QALY.