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D. L. Chang, M. L. Subramanian, P. A. Legutko, M. K. Daly; Cost-Benefit Analysis on the Use of Optical Coherence Tomography versus Fluorescein Angiogram in the Diagnosis of Macular Diseases at the VA Boston Healthcare System, Jamaica Plain Campus. Invest. Ophthalmol. Vis. Sci. 2008;49(13):1860. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
The Veterans Administration (VA) Healthcare System is active in providing cost-effective, high quality patient care. Optical coherence tomography (OCT) and fluorescein angiogram (FA) are imaging modalities utilized in the diagnosis of macular diseases. OCT has the benefit of being quick, inexpensive and non-invasive compared to FA. However, high upfront cost can present an obstacle to purchasing the OCT for some VA campuses. We proposed to conduct a cost-benefit analysis to determine how the introduction of OCT impacted on the number of FAs being performed for the diagnosis of macular diseases at the Jamaica Plain (JP) Campus.
A retrospective chart review was conducted at the VA Boston Department of Ophthalmology. Patients (pts) were selected if they obtained an FA and/or OCT based on a clinical indication of either macular edema and/or age-related macular degeneration (AMD) during a 1 year period before or after acquisition of the OCT in Sept., 2005. Exactly 1102 pt charts were reviewed. Healthcare dollars spent on FA and OCT were standardized and based on CPT codes. Adverse events (AEs) associated with FAs were documented and costs from AEs were based on CPT codes.
The year before OCT was obtained, 411 FAs were performed on 314 pts, with an average of 1.3 tests/pt at a cost of $297,498. Three AEs occurred with FAs (0.73 AEs/100 pts) at a cost of $688/100 pts. The year after OCT was obtained, 692 diagnostic imaging procedures were performed on 378 pts, with an average of 1.8 tests/pt at a cost of $325,695 (336 FAs at $243,210 and 356 OCTs at $82,485). This resulted in an increase in total diagnostic testing by 68% and an increase in total cost of only 9.5% from the year before. Two AEs occurred with FAs (0.60 AEs/100 pts) at a cost of $421/100 pts. As expected, no AEs occurred with OCT. Sub-group analyses for pts with macular edema and AMD yielded similar findings.
Our data suggest that introduction of OCT led to a dramatic number of OCTs being performed at the VA Boston. The acquisition of the OCT benefited the VA by improving quality of patient care for macular diseases, increasing available diagnostic testing for patients and decreasing the risk of AEs associated with FAs. The OCT led to a substantial relative cost savings when compared to FA alone and the purchase price of the OCT was recovered within 4 months of its acquisition.
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