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Erin Sieck, Anne M Lynch, Jennifer L Patnaik, Jasleen K Singh; Cost Comparison of Different Treatment Approaches to Dacryocystitis and Dacrocystocele. Invest. Ophthalmol. Vis. Sci. 2018;59(9):105.
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© ARVO (1962-2015); The Authors (2016-present)
Congenital dacrocystocele with potential for dacryocystitis is a common ophthalmic finding in children. There are multiple surgical approaches to open the mucocele that can include ophthalmology, otolaryngology or a combination of both specialists.The purpose of this study was to determine the financial impact of differing surgical approaches to treatment of dacrocystocele and dacryocystitis.
A retrospective chart review was conducted of 23 children who were treated for dacrocystocele (n=9) or dacryocystitis (n=14) at Children’s Hospital of Colorado from January 2012 to July 2015. Treatment options included nasal endoscopy preformed at bedside (n=1) or in the operating room (OR) (n=4), nasolacrimal duct (NLD) probing (n=5), or a combination of endoscopy and NLD probe (n=9). Four patients had no surgical intervention. The surgeries were preformed by otolaryngology (n=5), ophthalmology (n=5) or both specialties (n=9). Cost of the procedure, length of anesthesia and location was collected. Additional fees for NLD stents and antibiotics were included.
A bedside nasal endoscopy preformed by otolaryngology was $435 in addition to inpatient fees. Otolaryngology alone preforming a nasal endoscopy had an average OR fee $14,557 (SD $7,598) for 108.5 minutes (SD 87.0) minutes of operating time. Ophthalmology alone preforming a NLD probe had an average OR fee $5,540 (SD $1,752) for 31.0 minutes (SD 8.6) of operating time. A combination of both specialties preforming NLD probe and nasal endoscopy had an average OR fee $10,325 (SD $4,137) for 69 minutes (SD 34.5) of operating time. Ophthalmology alone had one patient with reoccurrence and placed Crawford stents ($569) in 2 of the 5 patients.
The most cost effective intervention was found to be the bedside nasal endoscopy as it removed the cost of the OR and general anesthesia. Ophthalmology alone was the most cost effective of OR interventions given the shortest operating times. NLD probing alone, however, had a higher rate of reoccurrence and additional cost of NLD stents. The combination of both ophthalmology and otolaryngology was more cost effective than otolaryngology alone and had no reoccurrence of disease. As healthcare reimbursement shifts towards cost effective medicine, this study can guide surgical approach considerations.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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