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Allison E. Babiuch, Mahdi Basha, Nicholas Tosi, Jonathan Nussdorf; Opportunity Costs of a One-Year Follow-Up of Tube Versus Trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):642.
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To report opportunity cost of a 1-year follow-up based on a study similar to the Tube Versus Trabeculectomy (TVT) Study.
Based on the TVT Study inclusion and exclusion criteria, patients between ages 18 and 85 years of age who had either a 350-mm2 Baerveldt glaucoma implant or trabeculectomy with mitomycin C (MMC 0.4mg/ml for 4 minutes) were reviewed and evaluated. Two clinic centers, one a community based hospital with surgeries performed by residents and fellows, the other a medical center with surgeries performed by glaucoma specialists. After evaluating outcome measurements including IOP, visual acuity, use of supplemental medical therapy and surgical complications between both surgeries, opportunity costs were derived based on mean visits during the surgical global period and over a one-year period. Interventional visits were also evaluated including but not limited to suture lysis and anterior chamber reformation. Using the medicare reimbursement fee schedule for noncomprehensive ophthalmic visits, Baerveldt surgery and Trabeculectomy surgery in the state of Louisiana opportunity costs were obtained.
A total of 53 eyes were analyzed with 26 eyes undergoing trabeculectomy and 27 eyes undergoing Baerveldt tube implantation. At one year, IOP was 14.9 mm Hg ± 4.2 in the trabeculectomy group and 12.4 mm Hg ± 3.9 in the tube group. Surgical success, as defined by the TVT study, was similar with 82% for trabeculectomy group and 83% for the Baerveldt group. Mean number of visits in a one year period was 12.27 ± 3.1 in trabeculectomy and 9.41 ± 2.6 in Baerveldt. Mean number of visits in a one year period was 12.27 ± 3.1 in trabeculectomy and 9.41 ± 2.6 in Baerveldt. Mean number of interventional visits in a one year period was 2.00 ± 1.13 in the trabeculectomy group and 0.15 ± 0.4 in the tube period. Taking the medicare reimbursement fee schedule for noncomprehensive ophthalmic visits, and the difference in reimbursements between Baerveldt surgery and Trabeculectomy surgery in the state of Louisiana, opportunity costs was obtained to be $737.20 per surgery in a one-year follow-up period.
In a one-year follow-up study based on the Tube versus Trabeculectomy (TVT) study in 2 distinctive clinical centers with surgeons of varying surgical experiences, our results were similar to that documented by the TVT study in terms of equal IOP reduction and use of supplemental medical therapy. With similar surgical successes it was calculated that on average the opportunity cost of performing Baerveldts over Trabeculectomy was $737.20 per surgery in a one-year follow-up.
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