Desai Neel R, Adams Bryan
Ophthalmology, The Eye Institute of West Florida, Largo, FL, USA.
Clin Ophthalmol. 2023 Apr 14;17:1137-1146. doi: 10.2147/OPTH.S396159. eCollection 2023.
To determine the health economic opportunity cost or gain associated with performing pterygium excision surgery using the TissueTuck technique with cryopreserved amniotic membrane (AM) instead of conjunctival autograft (CAU).
We performed a literature review to determine the average surgical duration of pterygium surgery using CAU with fibrin glue or sutures to calculate the average time saved with the TissueTuck technique. Such time savings was then used to determine the opportunity revenue gain per national average Medicare reimbursement if adjusted to the average surgical duration of cataract surgery.
The time savings achieved using the TissueTuck technique over CAU with fibrin glue is 8.9 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $1167 or $762 per 2022 National Average Medicare reimbursement, respectively. After subtracting the current list cost of AmnioGraft (ie, $645), the opportunity gain is $522 or $117 if the time saving is applied to the above procedures, respectively. Alternatively, the time savings achieved by using the TissueTuck technique over CAU with sutures is 23.4 min per procedure, which can be applied to additional MSICS or phacoemulsification procedures to generate an opportunity revenue gain of $3068 and $2004 per TissueTuck procedure or $2423 or $1359 when accounting for the list cost of AmnioGraft, respectively.
The TissueTuck surgical technique using cryopreserved AM for pterygium takes less time, has lower recurrence rates, and provides an opportunity gain compared to pterygium excision with CAU.
确定使用组织嵌入技术联合冷冻保存羊膜(AM)而非结膜自体移植(CAU)进行翼状胬肉切除手术所带来的健康经济机会成本或收益。
我们进行了文献综述,以确定使用CAU联合纤维蛋白胶或缝线进行翼状胬肉手术的平均手术时长,从而计算出使用组织嵌入技术节省的平均时间。然后,将节省的时间用于确定按照白内障手术的平均手术时长进行调整后,每次全国平均医疗保险报销的机会收益增加额。
与使用纤维蛋白胶的CAU相比,使用组织嵌入技术每次手术可节省8.9分钟,若将节省的时间应用于额外的小切口白内障囊外摘除术(MSICS)或超声乳化手术,则按照2022年全国平均医疗保险报销标准,分别可产生1167美元或762美元的机会收益增加额。减去当前羊膜移植片(AmnioGraft)的标价成本(即645美元)后,若将节省的时间应用于上述手术,机会收益分别为522美元或117美元。另外,与使用缝线的CAU相比,使用组织嵌入技术每次手术可节省23.4分钟,若将节省的时间应用于额外的MSICS或超声乳化手术,则每次组织嵌入手术可产生3068美元和2004美元的机会收益增加额;若考虑羊膜移植片的标价成本,则分别为2423美元或1359美元。
与使用CAU进行翼状胬肉切除相比,使用冷冻保存羊膜的组织嵌入手术技术用时更少,复发率更低,且提供了机会收益。