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Corneal prosthesis confers 20.3% improvement in patient quality of life
Am J Ophthalmol. 2010;149(2):221-228.
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A commonly used corneal prosthesis proved cost-effective compared with non-intervention and could be used in patients who are at risk of keratoplasty graft failure, according to a study.
The Boston keratoprosthesis conferred an exponential improvement in utility and patient quality of life, the study authors said.
"Despite initial cost, use of the Boston keratoprosthesis results in a significant transference of health value, equivalent to a 20.3% improvement in quality of life over no therapy for severe corneal disease, and should be strongly considered by providers as a highly cost-effective option for patients with, or at risk for developing, keratoplasty graft failure," the authors said.
The retrospective cohort study included 82 patients with a mean age of 65 years who underwent implantation of the prosthesis for various indications, such as fungal infection, idiopathic or microbial ulceration, herpes simplex virus and varicella zoster virus. Investigators excluded patients with autoimmune diseases and chemical burns. Clinical assessment included preoperative and postoperative best corrected visual acuity at 2-year follow-up.
Investigators performed cost-utility analysis to determine cost-effectiveness of the prosthesis, comparing prosthesis surgery to non-intervention. Cost-effectiveness was compared to that of penetrating keratoplasty. Utilities and costs were discounted 3% in accordance with common practice.
Comparative effectiveness, or gain in quality-adjusted life years (QALYs), was also calculated.
Study data showed that the average cost-effectiveness of the prosthesis for Medicare was $16,140 per QALY. The average utility improvement for keratoprosthesis was 0.182, compared with 0.119 for PK.
A total discounted incremental QALY gain of 0.763 was obtained for the keratoprosthesis. This correlated with an average conferred QALY gain, or improvement in quality of life, of 20.3%, the authors said.
KPro patients often experience a considerable improvement in their vision, many going from hand motion to 20/200 and some improve to 20/20. The recipients of KPros often discuss how dramatically their lives are changed after receiving the implant. For example, Dr. Dohlman has several patients who saw their children for the first time after receiving a KPro and others who went on to get a college education. This paper is interesting because it reflects the economic impact of the improved quality of life for KPro patients. This has important implications, especially when considering that there are 8 million people who are blind from cornea disease worldwide.
– Joseph B. Ciolino, MD
Massachusetts Eye
and Ear Infirmary, Harvard Medical School, Boston
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