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Economic impact of the advent of posterior lamellar keratoplasty in Montreal, Quebec

  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Catherine Beauchemin
    Correspondence
    Correspondence to Catherine Beauchemin, MSc, Faculty of Pharmacy, University of Montreal, P.O. Box 6128, Station Centre-Ville, Montreal QC H3C 3J7
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Faculty of Pharmacy, University of Montreal, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Isabelle Brunette
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Department of Ophthalmology, University of Montreal, Montreal, Que.

    Department of Ophthalmology, University of Montreal, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Hélène Boisjoly
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Department of Ophthalmology, University of Montreal, Montreal, Que.

    Department of Ophthalmology, University of Montreal, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Ellen E. Freeman
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Department of Ophthalmology, Maisonneuve-Rosemont Hospital, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Mihaela Popescu
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Department of Ophthalmology, Maisonneuve-Rosemont Hospital, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Jean Lachaine
    Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
    Affiliations
    Faculty of Pharmacy, University of Montreal, Montreal, Que.
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  • Author Footnotes
    1 Presented at the annual meeting of the Canadian Ophthalmological Society in Toronto, Ont., June 2009
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      Abstract

      Objective: To assess the cost-utility of posterior lamellar keratoplasty (PLK) techniques, including deep lamellar endothelial keratoplasty, Descemet stripping endothelial keratoplasty, and Descemet stripping automated endothelial keratoplasty, in the treatment of corneal endothelial diseases.
      Design: Cost-utility analysis based on a Markov model.
      Participants: Cohort of 100 patients waiting for corneal graft.
      Methods: This cost-utility analysis was performed from a Canadian health system perspective over a lifetime period. A Markov model was constructed to compare the cost per quality-adjusted life-year (QALY) associated with penetrating keratoplasty (PK) and PLK techniques. The model included all major health states relevant to patients scheduled for corneal transplant: waiting for transplant, surviving graft with or without complications, irreversible failure, noneligibility, and death. Transition probabilities among health states were obtained from published clinical trials. Costs considered were those associated with surgery, patients’ follow-up, and postsurgical complications. Number of QALYs was estimated presurgery and postsurgery using the Brown and Sharma conversion chart.
      Results: PLK proved to be more effective, providing more QALYs (+13 QALYs/100 patients), and it was less costly (−$68 792/100 patients) compared with PK. Deterministic and probabilistic sensitivity analyses confirmed the robustness of the base-case results.
      Conclusion: From a clinical and an economic standpoint, PLK in the management of patients waiting for corneal graft represents a preferred strategy compared with PK only.

      Résumé

      Objet: Évaluation de la rentabilite des techniques de keratoplastie lamellaire posterieure (KLP), y compris la kerato-plastie lamellaire endotheliale profonde, la keratoplastie endotheliale avec stripping de Descemet et la keratoplastie endotheliale automatisee avec stripping de Descemet, pour le traitement des maladies endotheliales de la cornee.
      Nature: Analyse de rentabilite selon un modele de Markov.
      Participants: Une cohorte de 100 patients en attente d’une greffe de la cornee.
      Methodes: Cette analyse de rentabilite s’inspire d’une perspective du regime de sante canadien pendant la durée de la vie. On a elabore un modele de Markov pour comparer le coût par annee de vie pondérée par la qualité (QALY) associé à la kératoplastie pénétrante (KP) et aux techniques de KLP. Le modèle comprend tous les principaux états de santé pertinents aux patients devant recevoir une transplantation cornéenne: patients en attente, ayant survécu à une greffe avec ou sans complications, échec irréversible, non éligibles et décédés. Les probabilités de transition entre les états de santé ont été tirées des publications sur les essais cliniques. Les coûts considérés ont été associés à ceux de la chirurgie, du suivi des patients et des complications postchirurgicales. Le nombre de QALY a été estimé avant et ap`es la chirurgie selon le tableau de conversion de Brown et Sharma.
      Résultats: La KLP s’est avérée plus efficace, donnant plus de QALY (+13 QALY/100 patients), et moins coûteuse (−68 792 $ / 100 patients) comparativement à la KP. Les analyses de sensibilité, déterministes et probabilistes, ont confirmeé la soliditeé des hypothèses de base.
      Conclusion: Du point de vue clinique et économique, la KLP offre une stratégie préférable à la KP seule pour traiter les patients en attente de greffe de la cornée.

      Keywords

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