TY - JOUR
T1 - Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media
AU - Gibbons, Allister
AU - Leung, Ella H.
AU - Yoo, Sonia H.
N1 - Funding Information:
Supported by an unrestricted grant from the National Institutes of Health Core Grant P30EY014801, Department of Defense Grant #W81XWH-13-1-0048, and a Research to Prevent Blindness Unrestricted Grant. The sponsor or funding organization had no role in the design or conduct of this research.
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
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U2 - 10.1016/j.ophtha.2019.11.012
DO - 10.1016/j.ophtha.2019.11.012
M3 - Article
C2 - 31892423
AN - SCOPUS:85077149549
VL - 127
SP - 582
EP - 588
JO - Ophthalmology
JF - Ophthalmology
SN - 0161-6420
IS - 5
ER -