Cost-effectiveness analysis : fibrin glue versus sutures for conjonctival fixation during pterygion surgery

Pterygium surgery requires the removal of pterygium tissue and repair of the conjunctiva with either sutures or fibrin glue. The literature suggests that the cost of fibrin glue could be compensated by reducing procedure time and be more cost-effective. However, to our knowledge, no formal studies have examined this hypothesis.

Retrospective chart review of patients who received pterygium surgery with only sutures between January 2008 and January 2010, and those whose surgeons used fibrin glue with or without sutures, between April 2017 and November 2018. Equipment cost, operating room (OR) maintenance, and surgeon's remuneration were compared between the groups.

A total of 164 eyes were included. Three different procedure methods were noted: use of sutures only, combination of sutures and fibrin glue, or application of fibrin glue alone. The equipment cost was $97, $169.50, and $152.10 for the suture group, dual method, and fibrin-only method. Average procedure time was 35.8 minutes for the sutures-only group, 21.1 minutes for the dual method, and 25.6 minutes for the method using only glue. OR maintenance cost was $51.20 CAD per minute. The total cost for the method using only sutures was $2528.90, whereas the average cost for the protocol using only fibrin glue was $2063.

Although using fibrin glue for conjunctival graft adhesion increases the equipment cost, it significantly decreases procedure time, which allows a reduction of the total surgery cost. Therefore, fibrin glue is a more cost-effective approach than sutures alone.