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Michael C. Chen, Bennie H. Jeng; Comparative Cost Analysis of Surgeon-Cut Versus Eye Bank-Cut Donor Corneal Tissue for Endothelial Keratoplasty. Invest. Ophthalmol. Vis. Sci. 2012;53(14):25.
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To perform a comparative cost analysis of surgeon-cut and eye bank-cut donor corneal tissue for endothelial keratoplasty.
A model was constructed to compare the costs associated with surgeon-cut and eye bank-cut donor corneal tissue for endothelial keratoplasty. Cost analysis of surgeon-cut tissue was calculated using a "bottom-up" or "microcosting" approach. Costs of equipment, consumable supplies, labor, building space, and risk of unsuccessful attempts resulting in damaged tissue were considered. Costs of equipment and consumable supplies were based on the acquisition costs of the University of California, San Francisco Medical Center. Cost of labor was based on the national wage estimates from the US Department of Labor Bureau of Labor Statistics. Cost of building space was estimated from the Building Owners and Managers Association Experience Exchange Report. Cost of risk of damaged tissue was estimated based on a local eye bank’s rate of returned corneal tissue secondary to surgeon-induced damage, multiplied by the cost of an uncut donor cornea. The cost associated with an eye bank-cut donor cornea was based on the tissue processing fee of a local eye bank, which is a Medicare pass-through cost. All costs are reported in 2010 US dollars.
Assuming a 5 year lifespan of the Moria Microkeratome; a team consisting of a surgeon, a registered nurse, a certified scrub technician, and a sterilization technician; a time of 30 minutes to cut the cornea before the patient is brought into the operating room; a rate of one percent for returned corneal tissue secondary to surgeon-induced damage; and a 500 square foot operating room, the cost per surgeon-cut donor cornea is $301.90, $376.90, $526.90, and $826.90 if the number of cases performed per year are 104, 52, 26, and 13, respectively. The processing fee of a local eye bank to cut the donor corneal tissue is approximately $750.
In our model, cost per surgeon-cut donor corneal tissue decreases as the number of cases performed increases. Excluding other factors such as opportunity costs, the eye bank processing fee is equivalent to the cost associated with a surgeon-cut cornea if the surgeon were to perform 15 cases per year. These calculations may influence the practice patterns of providers and may have implications for determining how third party payer reimbursements are made.
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