Cost utility for penetrating keratoplasty in patients with poor binocular vision

Purpose: Cost-utility and cost-effectiveness analyses are of increasing importance to clinicians and health policy experts. This study determines the costs in Germany and other countries in relation to gain of utility for patients with bilateral poor vision owing to corneal disease undergoing penetrating keratoplasty (PK) in 1 eye. Design: A cost-utility analysis was performed using retrospective clinical data and high-level evidence-based data. Participants: Sixty patients (mean age, 46.3 years) with bilateral poor vision who underwent PK for corneal disease. Methods: Visual acuity and utility values were obtained before and 1 year after PK and after suture removal. A 10-year graft survival rate of 80% was assumed. Expenses included costs for the corneal transplant and surgery, medication, and optical rehabilitation. A discount rate of 5% was applied for costs and quality-adjusted life years (QALYs). Cost-utility analysis encompassed a 10-year period after surgery. Main Outcome Measures: The number of QALYs was calculated for the study group undergoing PK. This was divided into the cost of the procedure to get the number of euros spent per QALY gained. Results: Median binocular preoperative visual acuity was -log mean angle of resolution (-logMAR) 0.91 +/- 0.53 (Snellen equivalent 20/160) yielding a utility value of 0.67. After suture removal and optical rehabilitation, binocular visual acuity increased to median -logMAR 0.36 +/- 0.36 (20/46) with a utility value of 0.79. Over the 10 years after surgery and considering graft survival and discounting, a cost utility of 9551 per QALY was gained (equivalent to US$11 557). One-way sensitivity analysis yielded a range from 7706 to 12874 per QALY, highlighting the robustness of the model. Conclusions: Although an expensive procedure, PK is cost effective in patients with bilateral poor vision.