• Pediatric Ophth/Strabismus

    In this letter to the editor, authors David R. Stager Jr, MD, Joost Felius, PhD, and George R. Beauchamp, MD, make a third-party payer cost assessment for the treatment and care of congenital unilateral cataract with the larger goal of establishing a cost-utility framework for pediatric cataract care.

    Using a spreadsheet, Stager and his cohorts calculated the costs associated with a basic scenario plus complications. The basic scenario included congenital unilateral cataract extraction with anterior vitrectomy during the first year of life, followed by lens correction until placement of a secondary IOL at 6 years of age with spectacles thereafter. The scenario also included a regimen of alternate daily patching until 8 years of age, as well as office follow-up and regular examinations under anesthesia until 12 years of age. Complications included strabismus requiring one or two muscle surgeries, glaucoma, lens re-proliferation or secondary membranes requiring membrane removal, retinal detachment requiring scleral buckling, and edophthalmitis requiring vitrectomy and antibiotics. All complications were weighed by published rates of incidence.

    The resulting base cost estimate was $21,060 per patient, although the authors advised that this third-party payer estimate was based on Medicare reimbursement data, so the actual costs will likely be higher. When varied parameters including operating room costs, costs of optical aids and patches, incidence rate of complications, costs of office examinations, and the timing of the secondary IOL were taken into account, the resulting per-patient cost range was $15,079 to $27,041.