Abstract
Purpose :
The aim of this study is to evaluate the cost and outcome of the triple procedure (phacovitrectomy+posterior capsulotomy) in comparison to either phacovitrectomy/double or the sequential/single procedures in treating patients. The study considered societal perspectives and visual acuity as the measure of QALY (quality of adjusted life years).
Methods :
A prospective study was carried out at the Department of Ophthalmology, Oslo University Hospital (OUH) after approval from the Regional Committee for Medical and Health Research Ethics and signed patient consent was obtained. All eye examinations were performed prior to surgery, when a decision to undergo only vitrectomy (26%) or phacovitrectomy (74%) and/or capsulotomy was made upon presence or absence of lens opacification (cataract) or pseudophakia. Time during surgery and between surgeries was recorded, as well as surgical procedure codes to determine the reimbursed fee; in addition, medical- and transport cover costs were calculated, and probability of the advance effect was used to determine the probable cost of the double or triple procedure. Outcome information was collected from various published literature of random trials as well as the likelihood of complications after any given surgery.
Results :
23 eyes underwent triple procedure (mean surgery time: 37 min); 8 eyes underwent just vitrectomy (mean surgery time: 24 min). Posterior capsulotomy took on average 0.5 min; preparation and cataract procedure took 13 min. On average, the patients travelled 80km to the surgery unit (OUH) with average travel cost being 2374NOK (Norwegian kroner). In addition, the average reimbursement fee for the procedures ranged between 734NOK (YAG capsulotomy), 4432NOK (phaco) and 7702NOK (vitrectomy) as day procedures. In the double/triple procedures, lenses and laser reimbursements were not included, while the re-calculated reimbursements for the double/triple procedures were 10797/10974NOK without significant loss of QALY.
Conclusions :
The triple procedure has evidenced benefits to the health institution, surgeon and patients. For patients, it saves them travels, healing time and potentially costs; for health institutions, it justifies the calculated higher cost of double and triple procedure which are cost saving, thus worthy of recommending higher reimbursement rate for it.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.