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Comparative Cost Analysis of Pediatric and Adult Retinal Detachment Repairs Using Time-Driven Activity-Based Costing
Warren W Pan1, Salma Fleifil2, David S Portney1
1Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA.
Insights
Pediatric retinal detachment (RD) repair surgeries, particularly standard vitrectomy, incur significantly higher costs than adult procedures. Medicare reimbursement often fails to cover these increased costs, leading to net margin losses for pediatric RD repairs.
Area of Science:
- Ophthalmology
- Health Economics
- Surgical Cost Analysis
Background:
- Retinal detachment (RD) repair is a critical surgical intervention.
- Understanding the economic disparities in pediatric versus adult RD repair is essential for healthcare resource allocation and patient access.
- Previous studies have not comprehensively compared the costs and reimbursement of RD repair across different age groups and surgical complexities.
Purpose of the Study:
- To conduct a comparative analysis of the costs and Medicare reimbursement rates for pediatric versus adult retinal detachment repair surgeries.
- To evaluate the financial implications of different RD repair techniques (scleral buckle, standard pars plana vitrectomy, complex pars plana vitrectomy) in pediatric and adult populations.
Main Methods:
- Utilized Current Procedural Terminology (CPT) codes (67107, 67108, 67113) for scleral buckle, standard RD repair, and complex RD repair.
- Analyzed data from 103 pediatric and 549 adult cases between January 2017 and May 2024.
- Employed time-driven activity-based costing methodology for a detailed cost analysis.
Main Results:
- Scleral buckle repair costs were comparable between pediatric and adult patients.
- Pediatric standard RD repair exhibited significantly higher material, grand total, and day-of-surgery time costs compared to adults.
- Net margin losses were observed for pediatric standard vitrectomy and both pediatric and adult complex RD repairs under Medicare reimbursement.
Conclusions:
- Pediatric standard vitrectomy procedures are substantially more costly (60.8% higher) than those for adults.
- Medicare reimbursement inadequately covers the costs of pediatric standard vitrectomy and complex RD repairs in both age groups, resulting in financial losses.
- Surgical complexity and patient age significantly impact the cost-effectiveness and reimbursement adequacy of RD repair.
Abstract:
Purpose: To compare the costs and reimbursement rates of retinal detachment (RD) repair surgeries in pediatric vs adult patients. Methods: Current Procedural Terminology (CPT) codes for scleral buckle (67107), standard RD repair (67108), and complex RD repair (67113) from January 2017 to May 2024 were extracted. A total of 103 pediatric cases and 549 adult cases were included. A cost analysis was performed using the time-driven activity-based costing methodology. Results: For scleral buckles, total costs were not significantly different between the pediatric and adult groups ($8,884.23 vs $7,878.26, respectively; P = .14). For standard RD repair, there was a significant difference in total material costs ($1,366.71 vs $1,023.66; P = .0013), grand total costs ($8,163.56 vs $5,076.18; P < .001), and day-of-surgery time costs ($6,796.87 vs $4,087.74; P < .001) for pediatric vs adult cases, respectively. For complex RD repair, grand total costs ($10,261.2 vs $9,528; P = .14) were equivalent. Net margins of RD repair under Medicare were -$3,296.52 and -$2,323.55 for scleral buckle, -$2,568.45 and +$430.93 for standard pars plana vitrectomy (PPV) repair, and -$4,467.92 and -$3,745.72 for complex PPV repair, for pediatric and adult patients, respectively. Conclusions: Pediatric standard vitrectomy had 60.8% higher total costs compared with that of adults. There was a net margin loss for standard PPV in pediatric patients (-$2,568.45), with only 68.5% of costs covered under Medicare. Net margin losses were also observed for complex RD repairs in both pediatric (-$4,467.92) and adult surgeries (-$3,745.72), with 56.4% and 60.7% of the costs covered under Medicare, respectively. Pediatric standard vitrectomy, scleral buckle, and complex PPV had greater losses compared with adult surgeries.
