1. Cost-Effectiveness of the Type II Boston Keratoprosthesis Jared D. Ament, MD, MPH, Tomasz P. Stryjewski, BS, Siddharth Pujari, PhD, George Papaliodus, MD, James Chodosh, MD, MPH, Claes H. Dolman, MD, PhD Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA FINANCIAL DISCLOSURE: Some of the authors of this poster have received research funding and travel expense reimbursement from Dr. Dohlman’s Keratoprosthesis research fund. Dr. Dohlman nor do any of the authors receive any financial benefit from the sale of the Boston Keratoprosthesis.

2. Cost-Effectiveness of the Type II Boston Keratoprosthesis PURPOSE: A 2009 study 1 confirmed the cost-effectiveness (CE) of the type I Boston Keratoprosthesis (KPro); however, no studies exist in patient populations with the worst prognoses – autoimmune diseases and chemical burns. The type II KPro has been used in these difficult patients with varying degrees of success. We sought to determine the CE of the Boston Keratoprosthesis.

3. Cost-Effectiveness of the Type II Boston Keratoprosthesis METHODS: In a retrospective chart review, patients at the Massachusetts Eye and Ear Infirmary, who underwent KPro type II surgery over the last 10 years, were identified. Patients had to have a minimum of 5 year of visual acuity follow-up data recorded. In this study, patients with autoimmune diseases and chemical burns represented the majority of our sample. Eleven patients were included. CE was determined by cost-utility analysis (CUA). Complications and additional procedures were incorporated into a weighted cost decision tree. Retention was calculated as 72.7% was assumed at 5 years. Visual acuity values were converted to utilities and determined to be normally distributed per Shapiro-Wilk testing.

4. Cost-Effectiveness of the Type II Boston Keratoprosthesis RESULTS: Median preoperative best-corrected visual acuity in the treated eye was logMAR 2.3  0.7 (Snellen equivalent HM). Five years post-operatively, the median best-corrected visual acuity increased to logMar 1.30  1.17 (Snellen equivalent of 20/400). A total discounted incremental QALY gain of 0.668 was obtained for the type II keratoprosthesis. This correlates with a conferred QALY gain (or improvement in quality of life) of 8.7% for the average patient. The total discounted cost associated with this utility equaled $42,215. Using the current parameters, the cost-utility of the KPro from third-party insurer (Medicare) perspective was 63,196 $/QALY. The univariate sensitivity analysis resulted in a range of incremental cost-effectiveness ratios from 52,078 – 83,871 $/QALY.

5. Cost-Effectiveness of the Type II Boston Keratoprosthesis DISCUSSION: The type II KPro is not yet an established procedure in the US for complex ophthalmic patients, often because the proposed population has significant autoimmune disease. This represents an exceedingly difficult and recalcitrant patient population with significant comorbidities. Patients have either already failed multiple corneal transplantation or are not candidates for keratoplasty.

6. Cost-Effectiveness of the Type II Boston Keratoprosthesis DISCUSSION: A sub-analysis of 16 patients with only 2-years of follow-up revealed an average improvement in visual acuity from HM vision to 20/70. The average incremental utility increase for this cohort was exceedingly high at 0.278. This, when compared to a 0.177 average incremental utility increase in our 5 year cohort, represents a 57% increase in average utility change. Reassessing 2-year costs and conducting the appropriate cost-utility calculations yield a cost-effective value of 31,719 $/QALY for this 2-year sample. The cost effectiveness of type II KPro in this study was determined to be 63,196 $/QALY. These markedly disparate values illustrate that a dramatic change occurs in the type II KPro population after the 2-year postoperative period.

7. Cost-Effectiveness of the Type II Boston Keratoprosthesis DISCUSSION: Although more costly than type I, the intrinsic utility of this device allows for the type II KPro to remain a moderately cost-effective medical intervention.

8. Cost-Effectiveness of the Type II Boston Keratoprosthesis REFERENCES: 1) Ament JD, Stryjewski TP, Ciolino JB, Todani A, Chodosh J, Dohlman CH. Cost-Effectiveness of the Boston Keratoprosthesis. Am J Ophthalmol. 2010 Feb;149(2):221-228 2) Brown MM, Brown GC. How to interpret a healthcare economic analysis. Curr Opin Ophthalmol 2005;16(3):191-4.