Cost analysis of eye bank versus surgeon prepared endothelial grafts

Abstract

Background Selective lamellar corneal transplantation (keratoplasty) has overtaken full thickness penetrating keratoplasty as the graft choice for endothelial failure. Even more recently eye bank prepared tissues are becoming increasing popular as a way to reduce the risks of tissue loss and stress during endothelial keratoplasty preparation in the surgical theatre. This study compares costs between surgeon and eye bank prepared tissues for Descemet’s stripping automated endothelial keratoplasty (DSAEK) and Descemet’s membrane endothelial keratoplasty (DMEK). Methods Retrospective study conducted at the Royal Liverpool University Hospital including endothelial keratoplasties with a minimum of 6 months follow-up time. Cost analysis included surgical expenses, tissue acquisition fees, cost of patient’s ward admission and out-patient expenses, including cost of re-bubbling procedures, costs of visits, anterior segment imaging and optometrist visits within the first 6 months follow-up. Results Ninety-eight eyes of 98 patients were included in the study of which 42 underwent DSAEK surgery and 56 DMEK surgery. Cost analysis of surgical expenses in the DSAEK group showed a significant difference between using surgeon prepared and eye bank prepared tissue (£3866 ± 296 and £4389 ± 360, respectively; p < 0.01) and the same was found in the DMEK group (£3682 ± 167 and £4162 ± 167 for surgeon prepared and eye bank prepared tissues, respectively; p < 0.01). Cost of out-patient visits did not differ significantly in either group. Conclusions At the Royal Liverpool University Hospital, eye bank prepared tissues had higher surgical expenses compared to those prepared by the surgeon, while the post-operative care expenses were similar between the two groups.

Preloaded DMEK with endo-in technique: Standardizing and minimizing the learning curve over 5 years using 599 corneal tissues

“…15 In our setting, we have found that as pl-DMEK tissues save time in the surgery, both in terms of graft preparation and the graft opening time in the anterior chamber, it does have an impact on the overall costs. 16 A similar impact 17 has been reported in a different setting, with endo-out technique. In addition to the accountable factors as listed above, the pros in terms of reduced surgical stress and tissue wastage, less surgical postponements or cancellations due to tissue wastage leading to patient distress and, reducing graft preparation stress cannot be neglected.…”

Preloaded DMEK With Endothelium Outward: A Multicenter Clinical Study Using DMEK Rapid Device

“…However, another study reported that eye bank-prepared DMEK grafts incur relatively higher surgical expenses compared with surgeon-prepared DMEKs. 34 More multicenter studies with regard to cost analysis are required to further confirm the cost effectiveness of preloaded DMEK.…”

Clinical Outcomes of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium Inward: A 24-Month Comparative Analysis Between Fuchs Endothelial Corneal Dystrophy and Bullous Keratopathy

“…Hence, the eye banks initiated the provision of prestripping followed by preloaded DMEK grafts in response to reducing time, stress, costs, and efforts in the surgical theater. 28 In 2018, Busin et al 13 highlighted several advantages of preloaded DMEK grafts with endothelium trifolded inward that included 29.5% ECL with 19.6% rebubbling rates. In a similar study, Price et al 29 reported 28% ECL and 10% rebubbling with the endo-in format.…”