Cost, Utilization, and Complications of Corneal Transplant in Affordable Care Act Beneficiaries

A knowledge gap persists regarding the utilization of corneal transplant surgery among enrollees in Affordable Care Act (ACA) plans and the factors influencing associated costs and complications post-ACA implementation. This study investigates the demographics, costs, and complications of cornea transplant for patients insured under the ACA from 2015 to 2019.

A novel claims dataset of Affordable Care Act (ACA) marketplace plan subscribers was utilized. Multivariable logistic and linear regression models were used to assess demographics, cost, and complication rates of corneal transplant using demographic/clinical data and insurance plan type.

Among 26,997,610 enrollees, 0.005% (n = 1266) underwent cornea transplant. About 32.9% (n = 416) of patients experienced a postoperative complication, the most common being corneal transplant failure (15.6%) and infectious keratitis (11.5%). Insurance plan type was not associated with rate of postoperative complications (p = 0.87). Patients with different plan types incurred significantly different out-of-pocket (OOP) cost (p < 0.001), with patients on Silver cost-sharing reduction plans paying the lowest ($4).

This study is the first to assess the demographics, costs, and complications of corneal transplant patients within the ACA population. Our findings suggest that patients with higher cost-sharing subsidies experience lower OOP costs and may be more inclined to pursue corneal transplant than those on lower actuarial value plans.