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M. H. Oltmanns, M. Connor, J. W. Doyle, M. F. Smith; A Cost Comparison of Trabeculectomy Versus Glaucoma Drainage Device Surgery by the Novice Surgeon. Invest. Ophthalmol. Vis. Sci. 2009;50(13):443.
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Recent studies have reported equivalent intraocular pressure (IOP) lowering efficacy between trabeculectomy and glaucoma drainage device (GDD) surgery. However, postoperative management and complications following these surgeries, especially when done by novice surgeons, can be quite different. As such, cost effectiveness is an important consideration. In the present study, we compared the costs involved in the initial surgery and 90 day post-operative management of patients who underwent trabeculectomy and GDD implantation.
A retrospective chart review of patients who underwent trabeculectomy or GDD implantation between 7/2001 and 7/2007 was perfomed at the Malcolm Randall Veterans Hospital . Variables studied included initial operative cost, costs incurred for routine follow up, management of complications, and treatment of elevated IOP during the 90 day post-operative period (see table), as well as IOP outcomes.
There was no difference in mean final IOP between the two groups. However, in the high-cost categories of hospital admission and post-op clinic visits, trabeculectomy patients were 250% and 92% more expensive to manage respectively than were GDD patients. Reformation of flat anterior chambers was required more often in trabeculectomy patients, with a 225% greater cost in this group. Initial surgical cost was 36% higher with GDD patients. Both groups required glaucoma medications to control IOP, but the cost was 906% higher in the GDD group. Bandage contact lens use represented a very small cost in both groups, and 5 fluorouracil was a cost unique to the trabeculectomy group.
Trabeculectomy and GDD implantation are frequently utilized procedures for the management of patients with glaucoma. With recent evidence suggesting equivalent IOP reduction, cost containment is an important issue to consider. The results of this study suggest that GDD implantation is a highly cost-effective procedure for novice surgeons.
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