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COST-EFFECTIVENESS OF HUMAN LEUKOCYTE ANTIGEN MATCHING IN PENETRATING KERATOPLASTY

Published online by Cambridge University Press:  05 February 2014

Michael Bäumler ,
Leonie Sundmacher ,
Thomas Reinhard  and
Daniel Böhringer
Michael Bäumler
Affiliation:
Department of Health Service Management, Ludwig-Maximilians-University
Leonie Sundmacher
Affiliation:
Department of Health Service Management, Ludwig-Maximilians-University
Thomas Reinhard
Affiliation:
Eye Clinic of the University Medical Center, University of Freiburg
Daniel Böhringer
Affiliation:
Eye Clinic of the University Medical Center, University of Freiburg
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Abstract

Background: The matching of favorable human leukocyte antigen (HLA) combinations is rarely performed in penetrating keratoplasty procedures for primary prophylaxis of immune reactions. However, clinical studies suggest that the incidence of graft rejection decreases substantially when patients receive favorably matched grafts.

Objective: The aim of this study was to assess the cost-effectiveness of HLA matching for patients undergoing penetrating keratoplasty in everyday clinical practice.

Methods: In the absence of a randomized controlled clinical trial, we used administrative data from the Freiburg University Eye Hospital in Germany. Our study population consisted of all patients who underwent their first keratoplasty between 11/2003 and 01/2010 and for whom information on HLA histocompatibility was available. We used propensity score matching to estimate a causal effect of favorable HLA matching, parametric survival regression techniques to predict graft survival and expert opinion to model incremental cost for HLA matching. Because the availability of favorable HLA histocompatibility ultimately depends on the patients’ HLA phenotype, we modeled the incremental cost-effectiveness ratio (ICER) as a function of the probability that a patient will receive a favorably matched HLA, and used expert opinion to set a point estimate.

Results: We predicted that corneal grafts with favorable HLA matching were associated with improved rejection-free graft survival time (more than 1,000 days). We estimated the incremental cost of HLA matching at EUR 1,200 and the ICER at EUR 4.62 per additional day of graft survival.

Conclusions: The ICER of HLA matching is acceptable, given the high cost of alternative treatment and the shortage of corneal donors in Germany.

Keywords

Penetrating keratoplastyHLA matchingcorneal graffcost-effectiveness analysisadministrative data
Type
Assessments
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 1 , January 2014 , pp. 50 - 58
Copyright
Copyright © Cambridge University Press 2014 

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