Spontaneous Resolution Affects Cost of Tear Duct Probing

Cost of immediate or deferred nasolacrimal duct probing depends on spontaneous resolution rate

WEDNESDAY, May 11 (HealthDay News) -- The relative cost-effectiveness of immediate office-based probing surgery (IOPS) and deferred facility-based probing surgery (DFBS) for treatment of nasolacrimal duct obstruction in infants depends on the rate of spontaneous resolution, according to a study published in the May issue of the Archives of Ophthalmology.

Kevin D. Frick, Ph.D., from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues compared the relative cost-effectiveness of two methods of treatment for nasolacrimal duct obstruction. Using data from the literature, Medicare 2009 fee schedules, and consensus assumptions, a model was built for IOPS and DFPS deferred for six months. Sensitivity analyses were performed varying the rate of spontaneous resolution from 50 to 90 percent.

The investigators found that, as the rate of spontaneous resolution decreased, the cost per additional success for DFPS increased. Assuming a 75 percent spontaneous resolution rate during the six-month deferral period, IOPS was more expensive ($771 versus $641), and slightly less effective (93 percent versus 97.5 percent) compared with DFPS. The additional health care costs for IOPS per month of symptoms avoided was $44. At lower rates of spontaneous resolution (50 to 68 percent), IOPS costs were lower than DFPS ($2 to $342 less), and it was slightly less effective (2 to 3.8 percent). Assuming the spontaneous resolution rate was 90 percent, IOPS costs per month of symptoms avoided would be $169.

"Under the assumption that the spontaneous resolution rate is 75 percent, the surgeon's choice of IOPS or DFPS has little impact in terms of overall success rate or cost for a population," the authors write.

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