Skip to main content

  • Perioperative Multiuse Eyedrop Protocols Are Cost-Effective

    By Lynda Seminara
    Selected by Russell N. Van Gelder, MD, PhD
    Add to My Bookmarks

    Journal Highlights

    Ophthalmology, November 2022

    Download PDF

    Berkowitz et al. explored the cost-effectiveness of multiuse eyedrop protocols in the perioperative set­ting. Their analysis of adults who had ophthalmic surgery requiring preoper­ative dilation and intravitreal injection showed that vast cost savings would be achieved if one bottle of mydriatic eye­drops was used for multiple patients. According to the study model, the five-year savings per institution would exceed $240,000. Moreover, multiuse protocols would minimize waste.

    For this work, the authors used eco­nomic modeling with scenario analysis to estimate the economic value of using a bottle of mydriatic eyedrops for mul­tiple patients as opposed to discarding the bottle after use in just one patient. According to the multiuse protocol for mydriatic drops, the same bottle would be used for multiple successive patients until it is empty or has expired. The authors conducted similar analyses for a povidone-iodine protocol to precede intravitreal injections. The multiuse protocol for povidone-iodine assumes two drops for each patient and use in successive patients until the vial is empty or expired. The authors applied sensitivity analyses to test baseline model assumptions for various degrees of waste and case volume.

    Among 7,170 patients who required a full regimen of mydriatic drops during the five-year study, the multi­use protocol reduced the number of bottles needed by 97.1% (from 35,850 to 1,037). This represents a five-year estimated savings of roughly $240,000 per institution, assuming an average of 1,434 cases per year (base-case sce­nario). Similar results occurred with sensitivity analyses that accounted for practical limitations such as loss, expiration, or contamination of bottles used for multiple patients (savings range, 95%-97.5%). The size of mydri­atic drops made little difference in the cost savings (range, 96.7%-99.2%). As for preinjection povidone-iodine, the multiuse protocol would reduce the number of vials per institution by 99.6% (from 41,954 to 153 bottles) in a five-year period, yielding a savings of approximately $41,800. Findings of the sensitivity analyses were similar. The combined per-institution savings could total more than $280,000 per five-year period, before adjusting for inflation.

    This analysis suggests that multiuse protocols for mydriatic eyedrops would reduce the cost and environmental waste associated with surgeries requir­ing pupillary dilation. It also indicates that multiple-use povidone-iodine protocols could lower the cost of office procedures that require them. “Opportunities for cost and environmental waste reduction can help ensure finan­cial viability of care in high-cost oph­thalmology practices,” said the authors.

    The original article can be found here.