Posterior capsule tears during surgery pose financial burden to U.K. healthcare purchasers

This retrospective study assessed the additional cost to healthcare purchasers in the U.K. of a posterior capsule tear (PCT) during cataract surgery and found that it was significant. In the U.K., healthcare “purchasers” are primary care trusts that are part of the National Health Service (NHS) and commission primary, community and secondary care from providers. It would be interesting to do a similar study in the U.S.

Using the NHS national tariff, the authors calculated the cost of visits and procedures for 100 patients who experienced a PCT during cataract surgery between 2005 and 2009 and compared it with matched controls who underwent uncomplicated cataract surgery on the same day performed by a surgeon of the same grade (i.e., consultant, fellow or specialist registrar). Patients previously under review for ocular comorbidity aside from cataract were excluded.

Cases required a median of three additional postoperative visits compared with zero for controls, with a median follow-up of 74 days for cases compared with 21 days for controls (P = 0.000). The average cost of extra visits was £475 for cases and £69.2 for controls (P < 0.001).

The authors note that the cost differences were not as high as they had anticipated because the majority of additional visits were on an outpatient basis, which costs only 5 percent of some surgical interventions. Also notable is that the cost of a PCT rose after 2009 due to an increase in the tariff for vitreoretinal procedures. Using the new tariff, the total cost of the 22 additional interventions required for the cases in this study after PCT would increase by 54 percent from £20,768 to £32,085.

They conclude that a full cost analysis would be required to determine the financial implication of PCT for the healthcare provider and whether these costs are fully recovered from the purchaser.