PMID- 24499612
OWN - NLM
STAT- Publisher
LR  - 20240227
IS  - 1471-6348 (Electronic)
IS  - 0266-4623 (Linking)
DP  - 2014 Feb 5
TI  - COST-EFFECTIVENESS OF HUMAN LEUKOCYTE ANTIGEN MATCHING IN PENETRATING 
      KERATOPLASTY.
PG  - 1-9
AB  - 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.
FAU - Baumler, Michael
AU  - Baumler M
AD  - Department of Health Service Management, Ludwig-Maximilians-University.
FAU - Sundmacher, Leonie
AU  - Sundmacher L
AD  - Department of Health Service Management, Ludwig-Maximilians-University.
FAU - Reinhard, Thomas
AU  - Reinhard T
AD  - Eye Clinic of the University Medical Center, University of Freiburg.
FAU - Bohringer, Daniel
AU  - Bohringer D
AD  - Eye Clinic of the University Medical Center, University of Freiburg.
LA  - eng
PT  - Journal Article
DEP - 20140205
PL  - England
TA  - Int J Technol Assess Health Care
JT  - International journal of technology assessment in health care
JID - 8508113
EDAT- 2014/02/07 06:00
MHDA- 2014/02/07 06:00
CRDT- 2014/02/07 06:00
PHST- 2014/02/07 06:00 [entrez]
PHST- 2014/02/07 06:00 [pubmed]
PHST- 2014/02/07 06:00 [medline]
AID - S0266462313000603 [pii]
AID - 10.1017/S0266462313000603 [doi]
PST - aheadofprint
SO  - Int J Technol Assess Health Care. 2014 Feb 5:1-9. doi: 10.1017/S0266462313000603.