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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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References

REFERENCES

1. Federal Health Monitoring of Germany – Gesundheitsberichterstattung des Bundes. Krankheitskosten, 2011. www.gbe-bund.de (accessed 2013 January 15, 2013).Google Scholar
2. Brown, NN, Brown, GC, Sharma, S, Kistler, J, Brown, H. Utility values associated with blindness in an adult population. Br J Ophthalmol. 2001;85:327–331.Google Scholar
3. Armitage, WJ, Tullo, AB, Larkin, DFP. The first successful full-thickness corneal transplant: A comment on Eduard Zirm's landmark paper of 1906. Br J Ophthalmol. 2006;90:1222–1223.Google Scholar
4. Coster, DJ, Williams, KA. The impact of corneal allograft rejection on the long- term outcome of corneal transplantation. Am J Ophthalmol. 2005;140:1112–1122.CrossRefGoogle Scholar
5. Birnbaum, F, Mayweg, S, Reis, A, et al. Mycophenolate mofetil (MMF) following penetrating high-risk keratoplasty: Long-term results of a prospective, randomised multicentre study. Eye (Lond). 2009;23:2063–2070.Google Scholar
6. Gomaa, A, Comyn, O, Liu, C. Keratoprostheses in clinical practice – a review. Clin Exp Ophthalmol. 2010;38:211–224.CrossRefGoogle ScholarPubMed
7. Duquesnoy, RJ. Antibody-reactive epitope determination with HLAMatchmaker and its clinical applications. Tissue Antigens. 2011;77:525–534.Google Scholar
8. Doxiadis, II, Smits, JM, Schreuder, GM, et al. Association between specific HLA combinations and probability of kidney allograft loss: The taboo concept. Lancet. 1996;348:850–853.Google Scholar
9. Böhringer, D, Daub, F, Schwartzkopff, J, et al. Operational post-keratoplasty graft tolerance due to differential HLAMatchmaker matching. Mol Vis. 2010;16:2362–2367.Google Scholar
10. Böhringer, D, Reinhard, S, Böhringer, T, et al. Predicting time on the waiting list for HLA matched corneal grafts. Tissue Antigens. 2001;59:407–411.Google Scholar
11. Böhringer, D, Reinhard, T, Sundmacher, R. Systematische EDV-gestützte Erfassung der Nachuntersuchungsdaten von Keratoplastikpatienten: 10-jähriger Erfahrungsbericht. Klin Monbl Augenheilkd. 2003;220:253–256.Google Scholar
12. Reinhard, T, Sundmacher, R, Godehardt, E, Heering, P. Systemische Cyclosporin-A-Prophylaxe nach Keratoplastiken mit erhöhtem Risiko für Immunreaktionen als einzigem erhöhten Risikofaktor. Ophthalmologe. 1997;94:496–500.Google Scholar
13. Rubin, DB. Matched sampling for causal effects. New York: Cambridge Press; 2006.Google Scholar
14. Bäumler, M, Stargardt, T, Schreyögg, J, Busse, R. Cost effectiveness of drug-eluting stents in acute myocardial infarction patients in Germany: Results from administrative data using a propensity score-matching approach. Appl Health Econ Health Policy. 2012;10:235–248.Google Scholar
15. Austin, PC. Some methods of propensity-score matching had superior performance to others: Results of an empirical investigation and Monte Carlo simulations. Biom J. 2009;51:171–184.Google Scholar
16. Austin, PC. A critical appraisal of propensity-score matching in the medical literature between 1996 and 2003. Stat Med. 2008;27:2037–2049.Google Scholar
17. Reis, A, Birnbaum, F, Reinhard, T. Systemic immunosuppressives after penetrating keratoplasty. Ophthalmologe. 2007;104:373–380.Google Scholar
18. Drummond, MF, Schulpher, MJ, Torrance, GW, O'Brien, JB, Stoddart, GL. Methods for the economic evaluation of health care Programmes. 3rd ed. New York: Oxford University Press; 2005.Google Scholar
19. Allison, PD. Survival analysis using SAS: A practical guide. 12th ed. Cary, NC: SAS Press; 2008.Google Scholar
20. Böhringer, D, Maier, P, Sundmacher, R, Reinhard, T. A cost calculation of an up-to-date eye Bank in Germany. In: Bredehorn-Mayr, T, Duncker, GIW, Armitage, WJ, eds. Developments in ophthalmology. Basel: Karger; 2009:120–124.Google Scholar
21. Birnbaum, F, Böhringer, D, Sokolovska, Y, Sundmacher, R, Reinhard, T. Immunosuppression with cyclosporine A and mycophenolate mofetil after penetrating high-risk keratoplasty: A retrospective study. Transplantation. 2005;79:964–968.CrossRefGoogle ScholarPubMed
22. Neymark, N, Adriaenssen, I, Gorlia, T, Caleo, S, Bolla, M. Estimating survival gain for economic evaluations with survival time as principal endpoint: A cost-effectiveness analysis of adding early hormonal therapy to radiotherapy in patients with locally advanced prostate cancer. Health Econ. 2002;11:233–248.Google Scholar
23. Bonastre, J, Chevalier, J, Elias, D, et al. Cost-effectiveness of intraperitoneal chemohyperthermia in the treatment of peritoneal carcinomatosis from colorectal cancer. Value Health. 2008;11:347–353.Google Scholar
24. Musch, DC, Schwartz, AE, Fitzgerald-Shelton, K, Sugar, A, Meyer, RF. The effect of allograft rejection after penetrating keratoplasty on central endothelial cell density. Am J Ophthalmol. 1991;111:739–742.Google Scholar