PURPOSE To determine the cost-effectiveness of Descemet's membrane endothelial keratoplasty (DMEK) compared with Descemet's stripping automated endothelial keratoplasty (DSAEK) in the United States. DESIGN Cost-effectiveness analysis in a surgical center in the United States. PARTICIPANTS Binocular adult patient undergoing endothelial keratoplasty. METHODS A base case of a 70-year-old man undergoing his first endothelial keratoplasty for bilateral Fuchs endothelial dystrophy. The cost-effectiveness of DMEK was compared with DSAEK over a 15-year time horizon. 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. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios and incremental cost-utility ratios, measured in cost per quality-adjusted life-years (QALYs). RESULTS Performing a DMEK instead of a DSAEK generated an extra 0.4 QALYs over a 15-year period. From a societal and third-party payer perspective, DMEK was cost-saving when compared with DSAEK in improving visual acuity in the base case. Probabilistic sensitivity analyses with variations in the costs and rebubble rates revealed that DMEK was cost-saving compared with DSAEK in 38% of iterations and was within a societal willingness-to-pay threshold of $50 000 in 98% of models. CONCLUSIONS From the societal and third-party payer perspectives in the United States, DMEK generated greater utilities and was less costly than DSAEK. Therefore, DMEK was the dominant procedure and was cost-saving with respect to DSAEK. The economic model was robust based on sensitivity analyses.

中文翻译：

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美国后弹力层膜内皮角膜移植术与后弹力层剥离内皮角膜移植术的成本效益分析。


目的 确定美国后弹力层膜内皮角膜移植术 (DMEK) 与后弹力层剥离自动内皮角膜移植术 (DSAEK) 的成本效益。设计美国一家外科中心的成本效益分析。参与者 接受内皮角膜移植术的双眼成年患者。方法 一名 70 岁男性因双侧 Fuchs 内皮营养不良而接受第一次内皮角膜移植术。对 DMEK 与 DSAEK 在 15 年时间范围内的成本效益进行了比较。并发症的发生率和费用来自 PubMed 英文文献检索、医疗保险报销和平均批发价格。所有成本每年贴现 3%，并根据通货膨胀调整至 2018 美元。使用确定性和概率敏感性分析来评估不确定性。主要成果衡量指标 增量成本效益比和增量成本效用比，以每质量调整生命年 (QALY) 的成本来衡量。结果 执行 DMEK 而不是 DSAEK 在 15 年期间额外产生了 0.4 QALY。从社会和第三方付款人的角度来看，在基本情况下，与 DSAEK 相比，DMEK 在提高视力方面节省了成本。对成本和起泡率变化的概率敏感性分析表明，在 38% 的迭代中，DMEK 比 DSAEK 节省成本，并且在 98% 的模型中处于 50 000 美元的社会支付意愿阈值之内。结论 从美国社会和第三方付款人的角度来看，DMEK 比 DSAEK 产生更大的效用且成本更低。因此，DMEK 是占主导地位的程序，并且相对于 DSAEK 来说可以节省成本。 基于敏感性分析，经济模型是稳健的。