Abstract
Purpose :
To determine the theoretical cost-effectiveness of adding antifungal agents
To cold storage media previous to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the United States (U.S.)
Methods :
Patients: A base case of a 70-year-old male undergoing his first endothelial keratoplasty for bilateral Fuchs’ endothelial dystrophy.
Intervention: The cost-effectiveness of adding an anti-fungal agent to cold storage media with DSAEK grafts, followed over a 15-year time horizon. The antifungal agents chosen were Voriconazole, Amphotericin, Caspofungin, and a combination of these. The incidences and costs of complications were derived from PubMed English literature searches, Medicare reimbursements, and average wholesale prices. All costs were discounted 3% per annum and adjusted for inflation to 2018 U.S. dollars. Uncertainty was evaluated using deterministic and probabilistic sensitivity analyses (PSA).
Main Outcome Measure: Incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR), measured in cost per quality-adjusted-life-years (QALY).
Results :
Adding antifungal agents add an extra 0.00013 – 0.00016 QALYs adjusted over a 15-year period. From a societal perspective, the addition of antifungal agents was considered to be within traditional willingness to pay parameters (WTP - under $150,000 USD) in the base case, irrespective of the antifungal used. PSA with variations in the type, costs of medications and complications rates revealed that the addition of an antifungal agent was within the societal WTP in 89% of iterations.
Conclusions :
From the societal and third-party payer perspectives in the U.S., the addition of an antifungal agent was within the parameters to be considered cost-effective. The economic model was robust based on sensitivity analyses.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.