Abstract
Purpose :
The objective of this study was to provide a cost-analysis detailing estimated savings through providing phenylephrine/ketorolac 1% / 0.3% (Omidria) intraocular solution during routine cataract surgery in both a Hospital Outpatient Department (HOPD) and Ambulatory Surgery Center (ASC) setting.
Methods :
An analysis was conducted of 963 eyes that underwent phacoemulsification and intraocular lens (IOL) implantation over the last seven years at the University of Utah Moran Eye Center with and without Omidria in the infusion solution. Consequent usage of pupillary expansion devices was recorded as well as patient sex, age, history of glaucoma, diabetes, pseudoexfoliative syndrome, intraoperative floppy iris syndrome, prior iris surgery, and tamsulosin usage. Comparison groups were balanced using inverse probability of treatment weights from propensity scores. Medicare facility reimbursement averages for complex (66982) and routine (66984) cataract removal and IOL placement were obtained. Rayner Inc. was consulted to provide a national average sale price (ASP) of Omidria for HOPD, 340B HOPD, and ASC settings. Other material costs were obtained from MicroSurgical Technology Inc. and a cost analysis was conducted using the number of cataract surgeries performed at the Moran Eye Center in 2021.
Results :
Statistical analysis yielded 552 eyes treated with Omidria and 411 eyes without. Strong evidence was found that those treated with Omidria have 0.17 (0.09 – 0.35) times the odds or a relative decrease of 83% use rate of pupillary dilation devices compared to those not treated (p-value < 0.001). The data reflected a 12.2% chance of using a pupil dilation device in cataract surgery when Omidria was not used compared to a 3.2% chance when used. Financial modeling was based on 3,830 cataract surgeries performed at the Moran Eye Center in 2021 and showed increased facility costs when Omidria was used in the HOPD and 340b HOPD setting, increasing facility costs by $1,775,827/year and $1,085,355/year respectively. In the ASC setting, due to Omidria being separately reimbursed by insurance, the use of the drug saved the facility $106,225/year.
Conclusions :
We conclude that Omidria offers less iris manipulation and can reduce ASC facility costs when given to all routine cataract surgery patients. Administering Omidria to every patient in the HOPD setting is more expensive than the alternative due to lack of insurance reimbursement.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.