PURPOSE To evaluate the cost-effectiveness of supplementing hypothermic cold storage media (CSM) with antifungal therapy. DESIGN Cost-effectiveness analysis (CEA). PARTICIPANT Base case of a patient with Fuch's endothelial dystrophy undergoing a first eye keratoplasty. METHODS Cost-effective analysis of the base case with corneal tissue stored in CSM or CSM supplemented with antifungal therapy over a 16-year time horizon. Multiple clinical scenarios were considered, including endothelial keratoplasty (EK) and penetrating keratoplasty (PK); amphotericin B, voriconazole, caspofungin, and combination therapy; and third-party payer and societal perspectives. The incidences were derived from PubMed literature searches and average wholesale prices of medications; all costs were discounted 3% per annum and adjusted for inflation to 2019 US dollars. MAIN OUTCOME MEASURES Incremental cost-effectiveness ratios (ICERs). RESULTS In the reference case, a corneal endothelial graft stored in amphotericin B-supplemented CSM was the most cost-effective approach from a third-party payer and societal perspective. Probability sensitivity analysis (PSA) of the societal model for the EK was robust, with 93.5% being below an arbitrary willingness-to-pay threshold (WTP) of $20 000 per fungal infection averted. Voriconazole, caspofungin, and combination antifungals were less cost-effective than amphotericin B. The main factors influencing the CEA were the incidences of postkeratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKs, antifungal supplementation was less cost-effective than for EKs. CONCLUSIONS Antifungal supplementation with amphotericin B for EK grafts was the most cost-effective approach of the studied antifungals; however, the CEA was sensitive to potential changes in graft failure rates, underlining the importance of long-term safety studies. For full-thickness corneal grafts, antifungal supplementation was less cost-effective.

中文翻译：

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角膜冷藏介质抗真菌补充剂的成本效果。

目的评估用抗真菌疗法补充低温冷库（CSM）的成本效益。设计成本效益分析（CEA）。研究对象Fuch内皮营养不良患者的首次眼角膜移植术。方法对16年内CSM或CSM补充抗真菌治疗的角膜组织病例进行成本效益分析。考虑了多种临床情况，包括内皮角膜移植术（EK）和穿透性角膜移植术（PK）。两性霉素B，伏立康唑，卡泊芬净和联合治疗; 以及第三方付款人和社会角度。发生率来自PubMed文献搜索和药物的平均批发价格；所有费用每年均贴现3％，并根据通货膨胀率调整为2019年美元。主要观察指标成本效益比（ICER）递增。结果在参考案例中，从第三方付款人和社会角度来看，储存在两性霉素B补充的CSM中的角膜内皮移植物是最经济有效的方法。EK的社会模型的概率敏感性分析（PSA）稳定可靠，其中93.5％低于任意避免的每次真菌感染20000美元的支付意愿阈值（WTP）。伏立康唑，卡泊芬净和组合抗真菌药的成本效益比两性霉素B低。影响CEA的主要因素是角膜移植术后真菌感染的发生率，移植失败的可能性增加以及抗真菌药的成本。对于用于PK的移植物，抗真菌补充剂的成本效益不如EK。结论在两用抗真菌药中添加两性霉素B的抗真菌剂是最经济的方法。然而，CEA对移植失败率的潜在变化很敏感，从而强调了长期安全性研究的重要性。对于全厚度角膜移植，补充抗真菌药的成本效益较低。