This Issue At A Glance

Although Descemet's stripping endothelial keratoplasty (DSEK) is more expensive to perform compared to the traditional full-thickness penetrating keratoplasty (PK) for endothelial disease, Bose et al (p. 464) found that DSEK should be the preferred treatment alternative from a cost-effectiveness perspective. The study demonstrated that for a given budget, it was possible to achieve greater quality adjusted life years (QALY) gains by providing DSEK to as many patients as possible – and no intervention to others – rather than providing PK. The retrospective cohort study involved 171 patients who underwent PK and 93 who underwent DSEK from January 2001 to December 2007. Three-year costs for DSEK were $7476 and $7236 for PK. Incremental cost effectiveness ratios were $567409 per QALY for PK relative to no intervention and $5209 per QALY for the DSEK relative to PK. The researchers suggest that DSEK patients would fare even better if follow-up had been longer, as late graft failures from endothelial loss would be more likely to occur with PK.