Kansal Vinay, Armstrong James J, Hutnik Cindy Ml
University of Saskatchewan, Department of Ophthalmology, Saskatoon, SK, Canada.
Western University Canada, Schulich School of Medicine, Department of Pathology and Laboratory Medicine, London, ON, Canada.
Clin Ophthalmol. 2020 Feb 20;14:501-508. doi: 10.2147/OPTH.S232873. eCollection 2020.
Glaucoma surgical management has evolved significantly with the introduction of minimally invasive glaucoma surgery. Our aim was to evaluate trends in Canadian glaucoma surgery billing code usage as a surrogate index of the current impact of this new technology in Canada's publicly funded health-care system.
Retrospective administrative health records analysis of all patients who underwent a publicly funded glaucoma filtration procedure from January 2003 to December 2016 in the 6 largest Canadian provinces. The frequency of glaucoma-related procedures was adjusted against primary open-angle glaucoma prevalence data. Frequency of all glaucoma filtration procedures with and without implantation of a drainage device in each province per year is reported.
Nationwide, glaucoma filtration procedures per 1000 primary open-angle glaucoma patients per year remained constant, with increased drainage device implantation over time (P<0.0001). Ontario and Nova Scotia mirrored the overall population. British Columbia and Saskatchewan showed increased rates of glaucoma filtration surgery, with increased drainage device implantations. In Quebec, overall filtration surgery decreased, while the rate of device implantation increased (p<0.0001). Alberta showed a decline in filtration surgery and device implantations from 2003 to 2008, and then increased thereafter.
Over the study period, there was a distinct trend towards billing code usage for implanted devices. Challenges encountered during this investigation highlight the need for identifiers in provincial health databases to accommodate the introduction of novel technologies. The absence of specific billing codes for newer technologies prevents accurate analyses of impact, utilization, efficacy and cost implications in contemporary patient management.
随着微创青光眼手术的引入，青光眼的手术治疗方法有了显著发展。我们的目的是评估加拿大青光眼手术计费代码的使用趋势，以此作为这项新技术在加拿大公共资助医疗系统中当前影响的替代指标。
对2003年1月至2016年12月在加拿大6个最大省份接受公共资助青光眼滤过手术的所有患者的行政健康记录进行回顾性分析。根据原发性开角型青光眼患病率数据对青光眼相关手术的频率进行调整。报告每年每个省份所有有或没有植入引流装置的青光眼滤过手术的频率。
在全国范围内，每年每1000例原发性开角型青光眼患者的青光眼滤过手术数量保持不变，随着时间的推移，引流装置植入量增加（P<0.0001）。安大略省和新斯科舍省与总体情况相符。不列颠哥伦比亚省和萨斯喀彻温省青光眼滤过手术率上升，引流装置植入量增加。在魁北克省，总体滤过手术减少，而装置植入率增加（p<0.0001）。艾伯塔省在2003年至2008年期间滤过手术和装置植入量下降，此后增加。
在研究期间，植入装置的计费代码使用有明显趋势。本次调查中遇到的挑战凸显了省级健康数据库中需要标识符以适应新技术的引入。缺乏针对较新技术的特定计费代码妨碍了对当代患者管理中的影响、利用、疗效和成本影响进行准确分析。
