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Omar Akhtar, Hargurinder Singh, William Hodge, ; A systematic review and cost-effectiveness analysis of disinfection methods for Goldmann Applanation Tonometry. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5582.
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Goldmann applanation tonometry presents the problem of being one of the most widely used pieces of equipment in the ophthalmic clinic and a known risk factor for the transmission of epidemic keratoconjunctivitis. The purpose of the current review is to assess the effectiveness of three methods of disinfection - alcohol swabs, immersion in peroxide and the use of disposable prisms. An economic evaluation is undertaken to assess the cost-effectiveness of the three alternatives. In doing so, we contribute an evidence-based overview of the issue at an opportune time, as several jurisdictions are developing protocols regarding tonometer tip disinfection.
A comprehensive literature review was undertaken with a librarian, comprising searches of 6 electronic databases and hand searches of the grey literature. A three-level screening process was undertaken by two reviewers according to pre-specified inclusion/exclusion criteria. Values from included papers were used to inform a cost-effectiveness analysis undertaken using a decision tree model implemented in TreeAge. The analysis was undertaken from the hospital perspective and included all equipment and labour costs.
Synthesis of in vitro data indicates that all three are plausible methods of disinfection with a 64% reduction in log growth of EKC when peroxide is used compared to alcohol swabs. The ICERs from the cost-effectiveness analysis were $12,000/case averted using peroxide and $61,000/case averted with Tonosafe as compared to alcohol.
Assuming clinical infection rates match in vitro disinfection data, the cost of bleach is high and the cost of Tonosafe is unacceptably high to reduce one potential case of adenoviral keratoconjunctivitis.
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