Cost benefit analysis of single- versus repeated-use of medical devices in cataract surgery
First Author: S.Palioura GREECE
To estimate the net cost effect (loss or benefit) associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus the proper single use of such devices in cataract surgery in Greece.
Repeated use of SUDs is common practice despite the safety and legal concerns raised by the European Union directive 93/42/EEC. This practice stems from the assumption that the cost reduction associated with repeated use of SUDs outweighs the costs of secondary complications that may emerge from such use.
A cost benefit analysis model was constructed in the form of a decision tree. A digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with the single and the repeated use of SUDs. The unit costs for the management of each complication in the model were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results.
When SUDs are reused, the expected cost of each complication is higher. The total additional cost per cataract surgery when SUDs are used only once is estimated at 174.04€, while when they are used repeatedly it is as high as 356.33€. The net present value (NPV) per cataract surgery (benefit minus cost), is -1,418.24€ for single use, while for repeated use the NPV is -1,503.19€. Consequently, single use of the SUDs results in 84.95€ lower NPV per patient or 84,950€ per thousand patients compared to the repeated use of SUDs in cataract surgery.
Our study is the first to attach a monetary value to the common yet questionable practice of SUD reuse. Repeated use of SUDs in cataract surgery is unethical, it jeopardizes patient safety and it carries a legal liability for the reuser. This study also shows that it is not cost beneficial. We, thus, expect that our results will have implications in policy formulations to improve the delivery of cataract healthcare.
receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented