Trial‐based cost‐effectiveness analysis of Descemet membrane endothelial keratoplasty (DMEK) versus ultrathin Descemet stripping automated endothelial keratoplasty (UT‐DSAEK).

Purpose: To evaluate the cost‐effectiveness of Descemet Membrane Endothelial Keratoplasy (DMEK) versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT‐DSAEK). Methods: A cost‐effectiveness analysis using data from a multicenter randomized clinical trial was performed. The time horizon was 12 months postoperatively. Patients with Fuchs' endothelial dystrophy were randomized to DMEK (n = 29) or UT‐DSAEK (n = 24). Relevant resources from healthcare and societal perspectives were included in the cost analysis. Quality‐Adjusted Life Years (QALYs) were determined using the Health Utilities Index Mark 3 (HUI3) and the EuroQol EQ‐5D‐5L questionnaires. The main outcome was the incremental cost‐effectiveness ratio (ICER; incremental societal costs per QALY). Results: Societal costs averaged €8851 (US$11 406) for DMEK and €8320 (US$10 722) for UT‐DSAEK. Higher costs in the DMEK group were mainly caused by higher rebubbling and regraft rates (21% and 7%, vs. 4% and 0% in the UT‐DSAEK group). HUI3 QALYs were 0.70 (DMEK) and 0.79 (UT‐DSAEK). EQ‐5D‐5L QALYs were 0.83 (DMEK) and 0.86 (UT‐DSAEK). The ICER indicated DMEK was dominated by UT‐DSAEK in both analyses. The cost‐effectiveness probability for DMEK ranged from 21% to 5% (HUI3 QALYs) and 27%–14% (EQ‐5D‐5L QALYs), assuming the maximum acceptable ICER ranged from €2500 to €80.000 (US$3222–US$103 093) per QALY. Conclusion: The base case cost‐effectiveness analysis favoured UT‐DSAEK over DMEK, as costs of DMEK were higher while QALYs were lower. Further studies are required to assess long‐term rebubbling and regraft rates and graft survival. [ABSTRACT FROM AUTHOR]