Long-Term Cost Analysis of Initial Panretinal Photocoagulation for Proliferative Diabetic Retinopathy Performed in the Operating Room vs the Clinic

Abstract

Purpose: To evaluate a treatment-naïve cohort of patients with proliferative diabetic retinopathy (PDR) and assess the costs of panretinal photocoagulation (PRP) initially performed in the operating room or the clinic, incorporating the cost of the additional follow-up procedures required for each treatment group. Methods: A retrospective review was performed of patients with PDR initially treated with PRP in the operating room or the clinic. Cost data were derived from Current Procedural Terminology codes, and estimated mean facility costs were provided. For each cohort, negative binomial regressions were used to compare counts of subsequent interventions, and visual acuity (VA) outcomes and dollars per patient-treatment year were compared with paired t tests. Results: Eighty-two eyes of 53 patients met the inclusion criteria. The operating room cohort included 56 eyes of 38 patients, while the clinic cohort included 26 eyes of 16 patients. Patients had a minimum follow-up of more than 3 years. The operating room cohort required fewer subsequent PRP treatments (mean, 1.0 vs 2.1; P < .05) and surgeries (mean, 0.3 vs 0.7; P < .05) than the clinic cohort. The mean best-corrected VA (BCVA) after treatment was significantly better in the operating room cohort (0.30 ± 0.40 logMAR; Snellen equivalent, 20/39.9) than the clinic cohort (0.75 ± 0.81 logMAR; Snellen equivalent, 20/112.5) (P < .05). The cost per patient-treatment year was similar between the cohorts (operating room, $5,886.79; clinic, $5,657.50) (P = .75). Conclusions: PRP initially administered in the operating room was equal in cost to clinic administration and required fewer subsequent PRP sessions and surgical treatments. In addition, there was a significant improvement in the final BCVA.