Cost of Phacovitrectomy Versus Vitrectomy and Sequential Phacoemulsification

PURPOSE: To evaluate and compare the cost of combined pars plana vitrectomy and phacoemulsification/intraocular lens implantation (phacovitrectomy) to a sequential approach to the surgical procedures for patients with an indication for vitrectomy and a visually significant cataract. METHODS: The total cost of both the combined and sequential approaches to surgery were calculated by combining the surgeon, ambulatory surgical center, and anesthesiology fees as reimbursed by Medicare. A univariate sensitivity analysis was also performed to examine the sensitivity of our estimations to changes in surgical duration. RESULTS: Phacovitrectomy afforded a 17% to 20% per-patient cost savings to Medicare (depending on the type of vitrectomy) compared with vitrectomy with sequential phacoemulsification. The conclusion that phacovitrectomy was less expensive than sequential surgery was robust in sensitivity analysis. CONCLUSION: Phacovitrectomy seems to be significantly less costly to Medicare than a sequential approach to surgery for patients with an indication for vitrectomy and a visually significant cataract.