Incremental Cost-Utility Analysis of Deep Anterior Lamellar Keratoplasty Compared with Penetrating Keratoplasty for the Treatment of Keratoconus

Alternatives to eye bank native tissue for corneal stromal replacement

“…Therefore DSAEK is a dominant strategy compared to PK, more effective and less costly. DALK has also been compared to PK in a cost-utility analysis performed in Singapore by Koo et al (Koo et al, 2011). Costs associated with DALK were higher than for PK, but the number of QALY gained were also higher with DALK.…”

Long-Term Clinical Outcomes of Deep Anterior Lamellar Keratoplasty in Patients With Keratoconus

“…12 Previous studies showed that DALK graft survival is longer than PK at short-and medium-term follow-up, [13][14][15][16] with a more favorable cost-benefit ratio in comparison to PK. 17 On the other hand, DALK, presenting a steep learning curve, requires longer operating time than PK, 9,[18][19][20][21][22][23][24][25][26][27][28] limiting the overall diffusion of this procedure. As DALK has only recently been introduced in many tertiary centers, reports of long-term postoperative outcomes of this procedure are scarce, often including different DALK techniques and patients with various corneal diseases grouped together.…”

New clinical pathways for keratoconus

“…Where transplantation is successful, irregular astigmatism and high postoperative anisometropia commonly prevent successful visual rehabilitation in spectacles without recourse to further surgical intervention. 4 Corneal transplantation is an effective but costly intervention in advanced keratoconus (stage IV modified Krumeich classification, 9 anterior 3 mm zone steep keratometry [K] 455D; Table 1), with an estimated incremental cost-utility ratio of between $1942 10 and $3025 11 per quality-adjusted lifeyear. The life impact of repeat intervention, and slow, often incomplete, visual rehabilitation after transplantation should not be underestimated.…”