Cost–Benefit Analysis of Single versus Repeated Use of Single-Use Devices in Cataract Surgery

Abstract

Purpose

To estimate the net cost effect associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus their proper single use in cataract surgery in Greece.

Design

A cost-benefit analysis model was constructed in the form of a decision tree.

Methods

A digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with single and repeated use of SUDs. Unit costs for the management of each complication were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results.

Results

Based on the probabilities of complications attained from the expert panel, repeated use of SUDs is associated with a higher chance of complications compared to single use, which results in higher cost of complication management. Under the healthcare sector perspective, the total expected cost per cataract surgery is 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 159.78€ the cost of adverse events) in the case of single use, while for repeated use the total cost is 1,486.29€ (1,146.86€ + 339.43€, respectively) and, thus, repeated use of SUDs in cataract surgery results in 82.31€ higher expected cost per patient compared to their single use. Moreover, the societal perspective analysis indicated even higher additional costs in the case of SUD reuse (108.24€).

Conclusion

Repeated use of SUDs in cataract surgery is not appropriate, it jeopardizes patient safety and carries a legal liability for the reuser. The present study, which is the first to attach a monetary value to the common yet questionable practice of SUD reuse, shows that it is not cost beneficial. Therefore, it is expected that the results will have implications in policy formulations to improve the delivery of cataract healthcare.

Keywords:

• cataract
• cataract surgery
• single-use devices
• SUDs

Abbreviations

OVD, ophthalmic viscosurgical device; SUD, single-use device; TASS, toxic anterior segment syndrome.

Ethics Statement

Ethical approval was not required for the present study. The participants were asked to provide only cumulative estimates based on their clinical practice and, thus, the study did not involve access to any patient data or protected health information (as defined by HIPAA) by the research team. Furthermore, the invitation letters explained to participants that their responses would be fully anonymized.

Disclosure

The present study has been financially supported by Alcon Laboratories Single Member S.A.C.I. Mrs Panagiota Naoum, Mrs Vasiliki Naoum, Mr Nikos Nomikos and Dr Konstantina Bachtalia, report grants from Alcon Laboratories Single Member S.A.C.I., during the conduct of the study. Dr Sotiria Palioura reports personal fees from Alcon, during the conduct of the study; personal fees from Alcon Laboratories, outside the submitted work; and is a consultant for Alcon Laboratories Single Member S.A.C.I. The authors report no other potential conflicts of interest for this work.