Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: a bottom-up approach

Elena Nicod (), Timothy L. Jackson, Federico Grimaccia, Aris Angelis, Marc Costen, Richard Haynes, Edward Hughes, Edward Pringle, Hadi Zambarakji and Panos Kanavos
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Elena Nicod: London School of Economics and Political Science
Timothy L. Jackson: King’s College London
Federico Grimaccia: London School of Economics and Political Science
Aris Angelis: London School of Economics and Political Science
Marc Costen: Hull and East Yorkshire Hospital
Richard Haynes: Bristol Eye Hospital
Edward Hughes: Sussex Eye Hospital
Edward Pringle: King’s College Hospital
Hadi Zambarakji: Whipps Cross Hospital
Panos Kanavos: London School of Economics and Political Science

The European Journal of Health Economics, 2016, vol. 17, issue 8, No 7, 999 pages

Abstract: Abstract Purpose The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV. Methods Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method. Results The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701. Conclusions The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries.

Keywords: Cost; Macular hole; Epiretinal membrane; Vitreomacular traction; Pars plana vitrectomy (search for similar items in EconPapers)
JEL-codes: I1 I19 (search for similar items in EconPapers)
Date: 2016
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DOI: 10.1007/s10198-015-0741-6

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