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

• Published in: American journal of ophthalmology 2020-11, Vol.219, p.222-230
• Main Authors: Trivizki, Omer, Karp, Michael R., Chawla, Anuj, Yamanuha, Justin, Gregori, Giovanni, Rosenfeld, Philip J.
• Format: Article
• Language: English
• Subjects: Aged; Angiogenesis Inhibitors - economics; Angiogenesis Inhibitors - therapeutic use; Bevacizumab - economics; Bevacizumab - therapeutic use; Choroidal Neovascularization - drug therapy; Choroidal Neovascularization - economics; Clinical medicine; Clinical trials; Cost control; Cost Savings - economics; Cost-Benefit Analysis; Drug dosages; Edema; Female; Humans; Intravitreal Injections; Male; Middle Aged; Monoclonal antibodies; Mydriatics - administration & dosage; Original; Patients; Physical Examination - economics; Pupil - drug effects; Receptors, Vascular Endothelial Growth Factor - therapeutic use; Recombinant Fusion Proteins - economics; Recombinant Fusion Proteins - therapeutic use; Regulatory approval; Retreatment; Schedules; Severe acute respiratory syndrome coronavirus 2; Tomography, Optical Coherence - economics; Treatment Outcome; Vascular endothelial growth factor; Vascular Endothelial Growth Factor A - antagonists & inhibitors; Visual Acuity; Wet Macular Degeneration - drug therapy; Wet Macular Degeneration - economics
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2020.06.028

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. Comparative cost analysis. 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. 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. 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.