Cost effectiveness of the type II Boston keratoprosthesis

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 $/qualityadjusted 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.

Prosthetic Replacement of the Ocular Surface Ecosystem as Treatment for Ocular Surface Disease in Patients with a History of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis

“…However, in this study of Boston keratoprosthesis, patients with autoimmune diseases such as SJS/TEN, who generally have a more complicated course and worse outcome, were not included in the analysis. In another paper by the same group, 28 the Boston type II keratoprosthesis (including patients with SJS/TEN) was found to have a cost utility of $63 196 per QALY.…”

Vision-Related Quality-of-Life Assessment Using NEI VFQ-25 in Patients After Boston Keratoprosthesis Implantation

“…3 Scholarly clinical research related to KPro outcomes is abundant in the literature. 6,7 Despite favorable outcomes, Boston KPro carries several risks and complications including glaucoma development or progression that can reach up to 76%, 8 lifelong risk of infectious endophthalmitis where a mean of 5.4% developed this infection over a period of 10 years, 9 sterile keratolysis and extrusion (5%-17%), 1-10 retroprosthetic membranes among the highest nonsurgical complications (24%-40%), 1,10,11 and retinal detachment (18.6%). 6,7 Despite favorable outcomes, Boston KPro carries several risks and complications including glaucoma development or progression that can reach up to 76%, 8 lifelong risk of infectious endophthalmitis where a mean of 5.4% developed this infection over a period of 10 years, 9 sterile keratolysis and extrusion (5%-17%), 1-10 retroprosthetic membranes among the highest nonsurgical complications (24%-40%), 1,10,11 and retinal detachment (18.6%).…”

Should Unilateral Congenital Corneal Opacities in Peters’ Anomaly be Grafted?

“…All patients included in our study presented extended corneal opacities and a rotation was not a therapeutic option. For multioperated cases and for graft rejections, some authors suggest keratoprosthesis, with satisfying results (16,18). The unique advantage of the latter is maintaining a clear visual axis and simultaneously correcting refractive errors immediately in the postoperative period.…”

“…Hirneiss et al (17), in their cost-effectiveness analysis, showed that keratoplasty is a cost-effective procedure. Recently, Ament et al (18), in their cost-utility analysis of keratoprosthesis versus keratoplasty, showed that keratoplasty, in quality-adjusted life-years, is less expensive. A keratoprosthesis is rarely performed primarily and is more likely to require additional surgery.…”