Abstract
Purpose
Despite demonstrated cost effectiveness, not all corneal disorders are amenable to type I Boston keratoprosthesis (KPro) implantation. This includes patients with autoimmune diseases, such as Stevens–Johnson syndrome/toxic epidermal necrolysis. Type II KPro is implanted through the eyelids in severe dry eye and cicatricial diseases, and its cost effectiveness was sought.
Patients and methods
In a retrospective chart review, 29 patients who underwent type II KPro surgery at the Massachusetts Eye and Ear Infirmary between the years 2000 and 2009 were identified. A total of 11 patients had 5-year follow-up data. Average cost effectiveness was determined by cost-utility analysis, comparing type II KPro surgery with no further intervention.
Results
Using the current parameters, the cost utility of KPro from third-party insurer (Medicare) perspective was 63 196 $/quality-adjusted life year.
Conclusion
Efforts to refer those less likely to benefit from traditional corneal transplantation or type I KPro, for type II KPro surgery, may decrease both patient and societal costs.
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Acknowledgements
We thank Kathy Colby, MD, PhD—Massachusetts Eye and Ear Infirmary and Ann Burke—Cost and Budget Manager. Both contributed to cost data.
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Competing interests
Dr Dohlman receives no personal profits from the sale of the Boston Keratoprosthesis. Proceeds go to the Massachusetts Eye and Ear Infirmary, and are used to support research and development. The authors are/were employees of the Massachusetts Eye and Ear Infirmary, and receive no financial benefit from the publication of this data. Dr Ament is a Clinical Research Fellow who is paid directly from Dr Dohlman's research and development fund.
Additional information
This work was presented as a poster at the World Cornea Congress Meeting in Boston, April 2010.
Author contributions
Design of the study (JA, TS, SP, SS, JC, and CD); conduct of the study (JA, TS, SP, SS, JC, and CD); analysis and interpretation (JA, GP, JC, and TS); writing the article (JA and TS); critical revision (JA, TS, SP, SS, GP, JC, and CD); final approval (JA, TS, SP, SS, GP, JC, and CD); data collection (JA, TS, SP, SS, and GP); provision of materials (SP, SS, GP, JC, and CD); statistical expertise (JA and JC); and literature search (JA and TS).
Ethics
The study was found to be exempted from review by the Human Studies Committee under Paragraph no. 4 of the Code of Federal Regulations 45 CFR 46.101(b). An IRB approval was received to collect data from medical records of patient. The project does not fall under HIPAA requirements because no protected health information is recorded or linked by code to data. The manuscript, its design, and implementation are in full adherence to the Declaration of Helsinki and all federal or state laws in the USA.
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Ament, J., Stryjewski, T., Pujari, S. et al. Cost effectiveness of the type II Boston keratoprosthesis. Eye 25, 342–349 (2011). https://doi.org/10.1038/eye.2010.197
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DOI: https://doi.org/10.1038/eye.2010.197
