Vitreoretinal Surgery Has Higher Costs in Europe, Postoperative Complications in US – AJMC.com Managed Markets Network


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Research presented at the American Society of Retina Specialists conference found that vitreoretinal surgery had cost and health implications in both Europe and the United States.
Researchers at the American Society of Retina Specialists conference presented data to suggest that vitreoretinal surgeries have higher costs in Europe compared with Asia, and patients experienced post-operative complications in the United States.

The research presented at the conference was retrieved from 2 studies on vitreoretinal surgery. The first,1 a review focusing on global costs of the surgery, searched for their studies in Ovid MEDLINE and Embase from November 12, 2014, to November 12, 2019. The second2 study, which focused on Medicare beneficiaries undergoing vitreoretinal surgery, enrolled participants from October 2015 to December 2017.

The review evaluated 5 articles that reported on the costs of 51 hospitals from Italy, England, Indonesia, Norway, and Greece. There were no articles from the United States included. Reports of surgery-specific costs were the most frequent, followed by staff, facility, and overall costs, respectively.

Costs for the study were converted and inflated to fit 2020 USD value. Inclusion criteria for the review included patients who reported diagnostic tests or procedures related to vitreoretinal surgery and were in English. The second study included patients who were continuously enrolled for greater than or equal to 12 months before the vitreoretinal surgery and greater than or equal to 1 month post-surgery.

Researchers for the review found that vitreoretinal surgery was between 8 and 15 times more expensive in Italy when compared with Indonesia, demonstrating large variations in cost. The minimum overall cost for a vitrectomy were from Indonesia, where the minimum cost was $233.71; a maximum overall cost of $2584.99 was reported in England, which demonstrated a discrepancy from Asia to Europe in vitrectomy surgeries.

The study conducted in the United States focused on 5094 patients who underwent 6699 vitreoretinal procedures from October 2016 to November 2017, of which 30.2% were performed in ambulatory surgical centers, 31.0% in hospital outpatient facilities, and 38.8% in physician offices. The mean age of the patients was 72.3 years and 91.1% were aged 65 years and older, with 86.5% identifying as White.

The study found that the most common complications of the vitreoretinal surgery were retinal edema (41.2%) and retinal detachment (27.7%). Posterior capsule opacification, retinal tera, blindness/low vision, and endophthalmitis were also reported complications of the procedure.

Comorbidities found before the first vitreoretinal surgery included cataract (57%), macular degeneration (47%), diabetes (46%), retinal detachment (26%), and proliferative diabetic retinopathy (24%).

Each procedure was preceded by 3.87 (95% CI, 3.79-3.96) pre-operative visits to an eye doctor within 6 months and there was a mean of 1.48 (95% CI, 1.21-1.77) post-operative visits over 3 months. The average post-operative out-of-pocket and Medicare costs per procedure over a 90-day period were $20 and $98 respectively.

The review and study demonstrated that vitreoretinal surgery came with both cost and health implications, as the procedure comes with increased price in Europe, out-of-pocket costs in the United States, and potential complications post-operation.

The study may help surgeons optimize postoperative outcomes and health care resources whereas the review could be important in providing benchmarks for critical value of vitreoretinal surgery.

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