July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Cost-Benefit Analysis of Supplementation of Amphotericin in Corneal Storage Media to prevent Post-Endothelial Keratoplasty Fungal Infections.
Author Affiliations & Notes
  • TsunKang "Trent" Chiang
    School of Medicine, Case Western Reserve University, Cleveland Heights, Ohio, United States
  • Gregory H Grossman
    Eversight, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   TsunKang "Trent" Chiang, None; Gregory Grossman, None
  • Footnotes
    Support  Eye Bank Association of America (EBAA) Research Grant
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 5218. doi:
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      TsunKang "Trent" Chiang, Gregory H Grossman; Cost-Benefit Analysis of Supplementation of Amphotericin in Corneal Storage Media to prevent Post-Endothelial Keratoplasty Fungal Infections.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5218.

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      © ARVO (1962-2015); The Authors (2016-present)

  • Supplements

Purpose : With the recent rise in incidences of post-endothelial keratoplasty (EK) fungal infections, we examine the economic possibility of supplementing intermediate-term corneal storage media (e.g.Optisol GS) with amphotericin. We want to know if it would be cost-effective to prevent these fungal infections, which often have devastating consequences, by supplementing amphotericin in all EK grafts.

Methods : Costs of post-EK fungal infection treatments are estimated from the literature review on Medline (PubMed) and Web of Science using six relevant MeSH terms. A total of 960 abstracts were reviewed, 86 articles were reviewed in full and we found 24 cases from 16 different articles to be relevant. Costs for amphotericin supplementation are conservatively estimated by consulting Eversight, a network of eye banks. Cost for medications and procedures are gathered from Medicare and the literature.
Lost utility due to fungal infections is calculated from examing the visual acuity (VA) from last office visit. The patient utility is converted from the VA using a polynomial equation.
Cost-Utility and cost-benefit analysis are conducted with varying levels of amphotericin effectiveness and post-EK fungal infection incidences.

Results : We estimated that given average (i.e. level between 2007-2014) incidences of post-EK fungal infection, the total annual costs of diagnosis and anti-fungal treatments for all post-EK fungal keratitis and endophthalmitis is $332,121. The annual total life-years lost due to post-EK fungal infections is 17.21 QALYs. Given a threshold of $100,000 USD/QALY, amphotericin supplementation is cost-effective if it can prevent more than 59.3% of the fungal infections compared to current regimen. Analysis of varying fungal infection incidences revealed that amphotericin supplementation would be cost-beneficial if incidences are at the level since 2011 or later.

Conclusions : Our analysis suggests that amphotericin supplementation is cost-effective at 100,000USD/Quality Adjusted Life Years (QALY) level as long as it had moderate effectiveness in reducing post-EK fungal infections. Given the increasing incidences of post-EK fungal keratitis or endophthalmitis since 2011, it is likely that our assumptions will hold in the future and amphotericin supplementation would remain cost-effective if it’s found to be effective in preventing fungal infection post-EK.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.



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