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Jasvir Virdee, George Moussa, Nicholas Gooch, Jesse Kigozi, Cristina Penaloza, Saaeha Rauz; Calculating the health economic burden of microbial keratitis (MK) admission in a tertiary referral centre in the UK.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3883.
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© ARVO (1962-2015); The Authors (2016-present)
The UK health care system (National Health Service, NHS) provides medical care that is available to all and free for all. MK is the commonest ophthalmic emergency admission in the developed world, with large cost burden to the NHS and few health economic studies. This study was designed to provide a quantification of direct costs of inpatient care for MK versus income generated though coding in a supra-regional tertiary centre in the UK.
Extensive clinical, demographic and economic data were collected retrospectively for a period of twelve months (Jan-Dec 2013) for 101 consecutive patients admitted with MK on a validated electronic proforma. Direct cost of admission (COA) was calculated using national reference costs for individual patients for various parameters including length of stay in days (LOS), topical medication, cost of microbiological services and cost of an ophthalmic hospital bed, together with health economic analytical assumptions to generate profit/deficit profiles based upon actual income and estimated expenditure A one-way ANOVA analysis was performed to compare groups.
The total income generated through discharge coding for all patients was £267,028, whilst calculated cost of admission was £382,473, giving an overall deficit of £115,445 per annum. The median individual deficit was £779 (interquartlie range £1880). The most critical factor driving the cost deficit was length of stay with median cost neutrality achieved between days 5 and 6 (table 1). Severity of microbial keratitis (graded according to Keay et al) was not found to be a significant factor in driving costs (Table 2). Surgical intervention (corneal gluing, evisceration) drove up costs of care.
Health economic analysis shows that length of stay is the key driver for direct costs of care for patients admitted with microbial keratitis with the pivotal LOS of 4 days. The microbial keratitis treatment pathway should encourage discharge of patients who are able to self-administer treatment after the sterilisation phase to enable financial parity. Prospective data collection is required to refine direct cost analyses and to evaluate the clinical and financial burden (indirect costs) of the impact of visual morbidity on quality of life.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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