A Cost-Minimization Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Payer, Patient, and Societal Perspectives in the United States
A Cost-Minimization Analysis Comparing Immediate Sequential Cataract Surgery and Delayed Sequential Cataract Surgery From the Payer, Patient, and Societal Perspectives in the United States
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DOI：
10.1001/jamaophthalmol.2014.2074
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发表时间：
2014-11-01
影响因子：
8.1
通讯作者：
Neel, Sean T.
中科院分区：
文献类型：
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作者：
Neel, Sean T.
重要性在美国对Medicare覆盖的患者进行延迟序贯白内障手术（DSCS）和立即序贯白内障手术（ISCS）之间的成本差异进行评估。目的从付款人、患者和社会的角度对西田纳西州地区和全国的ISCS与DSCS进行比较，进行成本最小化分析。使用白内障手术量和资格估计，2012年医疗保险报销计划，以及西田纳西州地区和全国的实际或估计患者成本数据进行成本最小化分析，比较ISCS与DSCS。西田纳西州的模式是建立在一个混合的小城市和农村私人执业环境，并推断为一个全国性的模式。门诊手术中心和医院门诊部设置costs.Main结果和措施西田纳西州和国家医疗保险支付者每名患者的成本和总的国家医疗保险支付者成本的DSCS和ISCS，以及西田纳西州和国家医疗保险患者（直接医疗、旅行和工资损失）的费用。据估计，2012年从DSCS转向ISCS后，医疗保险将减少约5.22亿美元的成本。随着ISCS的改变，西田纳西州医疗保险患者估计将直接医疗费用减少174美元，旅行费用减少40美元，工资损失减少138美元（总成本减少范围为329 - 649美元）。基于医疗保险的社会总成本降低了7.83亿美元。结论和相关性付款人和患者将受益于从DSCS到ISCS转换的经济角度。病人和他们的家人将受益于更少的访问。这一点变得很重要，因为随着婴儿潮一代的老龄化，未来将进行越来越多的白内障手术，特别是考虑到医疗保险已经在财政上捉襟见肘。需要进一步的研究，以评估从医生和手术设施的角度切换到ISCS的影响。
IMPORTANCE The cost difference is evaluated between delayed sequential cataract surgery (DSCS) and immediate sequential cataract surgery (ISCS) in the United States for patients covered by Medicare.OBJECTIVE To perform a cost-minimization analysis comparing ISCS with DSCS in the United States from the payer, patient, and societal perspectives for the West Tennessee region and nationally.DESIGN, SETTING, AND PARTICIPANTS A cost-minimization analysis using cataract surgery volume and eligibility estimates, 2012 Medicare reimbursement schedules, and actual or estimated patient cost data for the West Tennessee region and nationally was performed comparing ISCS with DSCS. The West Tennessee model was set in a mixed small city and rural private practice setting and was extrapolated to a national model. Ambulatory surgery center and hospital outpatient department setting costs were evaluated.MAIN OUTCOMES AND MEASURES West Tennessee and national Medicare payer costs per patient and the total national Medicare payer cost for DSCS and for ISCS, as well as West Tennessee and national Medicare patient (direct medical, travel, and lost wages) costs for DSCS and for ISCS.RESULTS Nationally, Medicare was estimated to reduce costs by approximately $522 million with the switch from DSCS to ISCS in 2012. With a change to ISCS, a West Tennessee Medicare patient was estimated to reduce costs by $174 for direct medical costs, $40 for travel costs, and $138 for lost wages (total cost reduction range, $329-$649). The total Medicare-based societal cost reduction was $783 million.CONCLUSIONS AND RELEVANCE Payers and patients would benefit from an economic standpoint by switching from DSCS to ISCS. Patients and their families would benefit from fewer visits. This becomes important given the increasing number of future cataract surgical procedures that will be performed as the baby boomer generation ages, especially given the fact that Medicare is already financially strained. Further research is needed to evaluate the effect of switching to ISCS from the physician and surgical facility perspectives.