Eliminating Visual Acuity and Dilated Fundus Examinations Improves Cost Efficiency of Performing Optical Coherence Tomogrpahy–Guided Intravitreal Injections

Omer Trivizki, Michael R. Karp, Anuj Chawla, Justin Yamanuha, Giovanni Gregori, Philip J. Rosenfeld

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The clinic efficiency and cost savings achieved by eliminating formal visual acuity (VA) and dilated fundus examinations (DFEs) were assessed for established patients receiving optical coherence tomography (OCT)–guided intravitreal injections. Design: Comparative cost analysis. Methods: Two different treatment models were evaluated. The first model included patients undergoing routine VA assessment, DFEs, OCT imaging, and intravitreal injections. The second model eliminated the routine VA assessment and DFE while using OCT imaging through an undilated pupil followed by the intravitreal injection. The 2 models incorporated both bevacizumab and aflibercept. The number of patients per clinic day, the cost per visit, and the daily revenues were compared between the 2 models. Results: Optimized schedules with and without VA assessments and DFEs allowed for 48 and 96 patients to be injected per day, respectively. Excluding drug costs, the cost per encounter for the visits with and without a DFE were $39.33 and $22.63, respectively. Including the drug costs, the costs per encounter for the visits with and without a DFE were $85.55 and $68.85 for bevacizumab and $1787.58 and $17770.88 for aflibercept, respectively. Once the reimbursements for each visit type were included, the clinics that eliminated the VA and DFEs were more cost efficient. Conclusion: Eliminating both VA assessments and DFEs for patients undergoing OCT-guided retreatment with intravitreal injections resulted in decreased exposure times between patients and clinic staff, decreased cost per encounter, and increased patient volumes per clinic day, resulting in improved clinic efficiency and safety while seeing more patients in a clinic day.

Original languageEnglish (US)
Pages (from-to)222-230
Number of pages9
JournalAmerican journal of ophthalmology
Volume219
DOIs
StatePublished - Nov 2020

Bibliographical note

Funding Information:
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. Funding/Support: Supported by grants from the Salah Foundation (Ft. Lauderdale, Florida, USA) , the National Eye Institute Center Core Grant ( P30EY014801 ) and Research to Prevent Blindness (unrestricted grant) to the Department of Ophthalmology , University of Miami Miller School of Medicine . The funding organizations had no role in the design or conduct of the present research. Financial Disclosures: Dr Rosenfeld receives research support from Carl Zeiss Meditec , Inc (Dublin, California, USA) and Stealth Biotherapeutics, is a consultant for Apellis, Biogen, Boehringer-Ingelheim, Carl Zeiss Meditec, Chengdu Kanghong Biotech, EyePoint, Ocugenix, Ocunexus, Ocudyne, and Unity Biotechnology, and has equity interest in Apellis, Valitor, Verana Health, and Ocudyne. Dr Gregori receives research support from Carl Zeiss Meditec , Inc and the University of Miami co-owns a patent that is licensed to Carl Zeiss Meditec , Inc. Drs Trivizki, Karp, Chawla, and Yamanuha indicate no financial conflict of interest. All authors attest that they meet the current ICMJE criteria for authorship.

Funding Information:
All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. Funding/Support: Supported by grants from the Salah Foundation (Ft. Lauderdale, Florida, USA), the National Eye Institute Center Core Grant (P30EY014801) and Research to Prevent Blindness (unrestricted grant) to the Department of Ophthalmology, University of Miami Miller School of Medicine. The funding organizations had no role in the design or conduct of the present research. Financial Disclosures: Dr Rosenfeld receives research support from Carl Zeiss Meditec, Inc (Dublin, California, USA) and Stealth Biotherapeutics, is a consultant for Apellis, Biogen, Boehringer-Ingelheim, Carl Zeiss Meditec, Chengdu Kanghong Biotech, EyePoint, Ocugenix, Ocunexus, Ocudyne, and Unity Biotechnology, and has equity interest in Apellis, Valitor, Verana Health, and Ocudyne. Dr Gregori receives research support from Carl Zeiss Meditec, Inc and the University of Miami co-owns a patent that is licensed to Carl Zeiss Meditec, Inc. Drs Trivizki, Karp, Chawla, and Yamanuha indicate no financial conflict of interest. All authors attest that they meet the current ICMJE criteria for authorship. Other Acknowledgments: None.

Publisher Copyright:
© 2020 Elsevier Inc.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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