Donor and surgical risk factors for primary graft failure following Descemet’s stripping automated endothelial keratoplasty in Asian eyes

Clinical Ophthalmology511503-150

Utilization rate and usage patterns of phakic and pseudophakic donor corneas recovered by the Singapore Eye Bank

10.1371/journal.pone.0260523PLOS ONE161

A cost-minimization analysis of tissue-engineered constructs for corneal endothelial transplantation.

Corneal endothelial transplantation or endothelial keratoplasty has become the preferred choice of transplantation for patients with corneal blindness due to endothelial dysfunction. Currently, there is a worldwide shortage of transplantable tissue, and demand is expected to increase further with aging populations. Tissue-engineered alternatives are being developed, and are likely to be available soon. However, the cost of these constructs may impair their widespread use. A cost-minimization analysis comparing tissue-engineered constructs to donor tissue procured from eye banks for endothelial keratoplasty was performed. Both initial investment costs and recurring costs were considered in the analysis to arrive at a final tissue cost per transplant. The clinical outcomes of endothelial keratoplasty with tissue-engineered constructs and with donor tissue procured from eye banks were assumed to be equivalent. One-way and probabilistic sensitivity analyses were performed to simulate various possible scenarios, and to determine the robustness of the results. A tissue engineering strategy was cheaper in both investment cost and recurring cost. Tissue-engineered constructs for endothelial keratoplasty could be produced at a cost of US$880 per transplant. In contrast, utilizing donor tissue procured from eye banks for endothelial keratoplasty required US$3,710 per transplant. Sensitivity analyses performed further support the results of this cost-minimization analysis across a wide range of possible scenarios. The use of tissue-engineered constructs for endothelial keratoplasty could potentially increase the supply of transplantable tissue and bring the costs of corneal endothelial transplantation down, making this intervention accessible to a larger group of patients. Tissue-engineering strategies for corneal epithelial constructs or other tissue types, such as pancreatic islet cells, should also be subject to similar pharmacoeconomic analyses

One-way sensitivity analysis.

<p>One-way sensitivity analysis of selected variables on the cost advantage of the tissue engineering strategy over the procured-tissue strategy. + indicates that the cost advantage increases as that variable increases, while - indicates that the cost advantage decreases as that variable increases. Abbreviations: GMP, Good Manufacturing Practice; QA, Quality Assurance.</p

Sensitivity ranges.

<p>Abbreviations: GMP, Good Manufacturing Practice; QA, quality assurance; EK, endothelial keratoplasty.</p

Tissue cost per transplant.

<p>Abbreviations: None.</p

Investment costs.

<p>Abbreviations: ALTK system, Automated Lamellar Therapeutic Keratoplasty system (Moria, Antony, France).</p

Recurring costs.

<p>Abbreviations: QA, Quality Assurance; GMP, Good Manufacturing Practice.</p