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The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus.
Cornea. 2008 Oct; 27(9):1001-7.C

Abstract

OBJECTIVE

To perform a base case, comparative effectiveness, and cost-effectiveness (cost-utility) analysis of penetrating keratoplasty for patients with severe keratoconus.

METHODS

Visual acuity data were obtained from a large, retrospective multicenter study in which patients with keratoconus with less than 20/40 best corrected visual acuity and/or the inability to wear contact lenses underwent penetrating keratoplasty, with an average follow-up of 2.1 years. The results were combined with other retrospective studies investigating complication rates of penetrating keratoplasty. The data were then incorporated into a cost-utility model using patient preference-based, time trade-off utilities, computer-based decision analysis, and a net present value model to account for the time value of outcomes and money. The comparative effectiveness of the intervention is expressed in quality-of-life gain and QALYs (quality-adjusted life-years), and the cost-effectiveness results are expressed in the outcome of $/QALY (dollars spent per QALY).

RESULTS

Penetrating keratoplasty in 1 eye for patients with severe keratoconus results in a comparative effectiveness (value gain) of 16.5% improvement in quality of life every day over the 44-year life expectancy of the average patient with severe keratoconus. Discounting the total value gain of 5.36 QALYs at a 3% annual discount rate yields 3.05 QALYs gained. The incremental cost for penetrating keratoplasty, including all complications, is $5934 ($5913 discounted at 3% per year). Thus, the incremental cost-utility (discounted at 3% annually) for this intervention is $5913/3.05 QALYs = $1942/QALY. If both eyes undergo corneal transplant, the total discounted value gain is 30% and the overall cost-utility is $2003. Surgery on the second eye confers a total discounted value gain of 2.5 QALYs, yielding a quality-of-life gain of 11.6% and a discounted cost-utility of $2238/QALY.

CONCLUSIONS

Penetrating keratoplasty for patients with severe keratoconus seems to be a comparatively effective and cost-effective procedure when compared with other interventions across different medical specialties.

Authors+Show Affiliations

Retina-Vitreous Associates, Los Angeles, CA 90017, USA. roe.rick@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18812762

Citation

Roe, Richard H., et al. "The Value-based Medicine Comparative Effectiveness and Cost-effectiveness of Penetrating Keratoplasty for Keratoconus." Cornea, vol. 27, no. 9, 2008, pp. 1001-7.
Roe RH, Lass JH, Brown GC, et al. The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus. Cornea. 2008;27(9):1001-7.
Roe, R. H., Lass, J. H., Brown, G. C., & Brown, M. M. (2008). The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus. Cornea, 27(9), 1001-7. https://doi.org/10.1097/ICO.0b013e31817bb062
Roe RH, et al. The Value-based Medicine Comparative Effectiveness and Cost-effectiveness of Penetrating Keratoplasty for Keratoconus. Cornea. 2008;27(9):1001-7. PubMed PMID: 18812762.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The value-based medicine comparative effectiveness and cost-effectiveness of penetrating keratoplasty for keratoconus. AU - Roe,Richard H, AU - Lass,Jonathan H, AU - Brown,Gary C, AU - Brown,Melissa M, PY - 2008/9/25/pubmed PY - 2008/12/17/medline PY - 2008/9/25/entrez SP - 1001 EP - 7 JF - Cornea JO - Cornea VL - 27 IS - 9 N2 - OBJECTIVE: To perform a base case, comparative effectiveness, and cost-effectiveness (cost-utility) analysis of penetrating keratoplasty for patients with severe keratoconus. METHODS: Visual acuity data were obtained from a large, retrospective multicenter study in which patients with keratoconus with less than 20/40 best corrected visual acuity and/or the inability to wear contact lenses underwent penetrating keratoplasty, with an average follow-up of 2.1 years. The results were combined with other retrospective studies investigating complication rates of penetrating keratoplasty. The data were then incorporated into a cost-utility model using patient preference-based, time trade-off utilities, computer-based decision analysis, and a net present value model to account for the time value of outcomes and money. The comparative effectiveness of the intervention is expressed in quality-of-life gain and QALYs (quality-adjusted life-years), and the cost-effectiveness results are expressed in the outcome of $/QALY (dollars spent per QALY). RESULTS: Penetrating keratoplasty in 1 eye for patients with severe keratoconus results in a comparative effectiveness (value gain) of 16.5% improvement in quality of life every day over the 44-year life expectancy of the average patient with severe keratoconus. Discounting the total value gain of 5.36 QALYs at a 3% annual discount rate yields 3.05 QALYs gained. The incremental cost for penetrating keratoplasty, including all complications, is $5934 ($5913 discounted at 3% per year). Thus, the incremental cost-utility (discounted at 3% annually) for this intervention is $5913/3.05 QALYs = $1942/QALY. If both eyes undergo corneal transplant, the total discounted value gain is 30% and the overall cost-utility is $2003. Surgery on the second eye confers a total discounted value gain of 2.5 QALYs, yielding a quality-of-life gain of 11.6% and a discounted cost-utility of $2238/QALY. CONCLUSIONS: Penetrating keratoplasty for patients with severe keratoconus seems to be a comparatively effective and cost-effective procedure when compared with other interventions across different medical specialties. SN - 1536-4798 UR - https://www.unboundmedicine.com/medline/citation/18812762/The_value_based_medicine_comparative_effectiveness_and_cost_effectiveness_of_penetrating_keratoplasty_for_keratoconus_ L2 - https://doi.org/10.1097/ICO.0b013e31817bb062 DB - PRIME DP - Unbound Medicine ER -