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Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media
Ophthalmology ( IF 7.732 ) Pub Date : 2019-11-21 , DOI: 10.1016/j.ophtha.2019.11.012
Allister Gibbons, Ella H. Leung, Sonia H. Yoo

Objective To evaluate the cost-effectiveness of supplementing hypothermic corneal storage media (CSM) with antifungal therapy Design Cost-effectiveness analysis (CEA) Subject Base case of a Fuch’s endothelial dystrophy patient 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 keratoplasties (EK) and penetrating keratoplasties (PKP); 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 U.S. 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 post keratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKPs, antifungal supplementation was less cost-effective than for EKs. Conclusions Antifungal supplementation with amphotericin B for endothelial keratoplasty 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.
更新日期:2019-11-22

 

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