Related Experiment Videos
Early office-based vs late hospital-based nasolacrimal duct probing. A clinical decision analysis
Insights
Early nasolacrimal duct probing in the office is as effective as late hospital probing for infants. Early probing is a more cost-effective strategy for treating nasolacrimal duct obstruction.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Health Economics
Background:
- Symptomatic nasolacrimal duct obstruction in infants presents treatment dilemmas.
- Two main strategies include early office probing or delayed medical management with late hospital probing.
Purpose of the Study:
- To compare the efficacy and cost-effectiveness of early versus late nasolacrimal duct probing in infants.
Main Methods:
- Clinical decision analysis using a decision tree model.
- Comparison of early office probing (6 months) versus late hospital probing (12 months).
- Inclusion of spontaneous resolution rates (70%) and procedural costs.
Main Results:
- Both early office and late hospital probing strategies achieve >99% success rates.
- Late hospital probing is estimated to cost $2,310,000 more per 10,000 patients.
- Fewer procedures were performed with the late hospital strategy.
Conclusions:
- Early office probing and late hospital probing offer comparable high success rates for nasolacrimal duct obstruction.
- Early office probing represents a more cost-effective treatment approach.
Background:
Controversy exists regarding the treatment of infants with symptomatic nasolacrimal duct obstruction. One philosophy advocates "early" nasolacrimal duct probing, generally in the office. An alternate strategy advocates medical management until the infant is approximately 12 months old to allow for spontaneous resolution, with those with persistent nasolacrimal duct obstruction usually treated by "late" probing in the hospital with the use of general anesthesia.
Methods:
We used clinical decision analysis to compare these two opposing treatment strategies. A decision tree was constructed with the usual designations for probability nodes and decision points, comparing early probing at 6 months of age in the office and late probing at 12 months of age in the hospital. The initial decision point thus addressed treatment of children who still had symptomatic nasolacrimal duct obstruction at 6 months of age. One repeated probing under same-strategy conditions was performed for patients in whom initial office probing failed. Values for probability nodes were derived from the ophthalmic literature, including a 70% rate of spontaneous resolution of nasolacrimal duct obstruction between the ages of 6 and 12 months.
Results:
Both the early office probing strategy and the late hospital probing strategy yielded success rates greater than 99%. Based on prevailing fees, the late hospital strategy cost $2,310,000 more than the early office strategy per 10,000 patients, even though fewer procedures were performed.
Conclusion:
Early office probing and late hospital probing have similar high success rates, albeit at a higher cost for the late hospital probing strategy.