Optical Coherence Tomography More Cost-Effective Than Fluorescein Angiogram in Diagnosing Macular Disease

April 29, 2008

April 29, 2008 (Fort Lauderdale) — The introduction of optical coherence tomography (OCT) at the Veterans Affairs (VA) Healthcare System in Boston, Massachusetts, improved the quality of patient care for macular disease and led to substantial relative cost savings compared with fluorescein angiogram (FA). The cost of the OCT was recovered after 4 months of use.

OCT and FA are imaging modalities used in the diagnosis of macular diseases. OCT is quick, inexpensive, and noninvasive compared with FA. Because of its high up-front cost, however, some VA campuses are reluctant to purchase an OCT system. The researchers at the VA conducted a cost-benefit analysis, presented here at the Association for Research in Vision and Ophthalmology 2008 Annual Meeting, to determine whether OCT would save money and also sought to find out whether using OCT would result in fewer patient adverse events associated with FA.

The Boston VA acquired the OCT system in September 2004 and then conducted a retrospective chart review of patients who underwent FA and/or OCT based on a clinical indication of either macular edema and/or age-related macular degeneration (AMD) during that 1-year period. A total of 1102 patient charts were selected and reviewed. Healthcare dollars spent on FA and OCT were standardized and based on current procedural terminology (CPT) codes. Adverse events associated with FAs were documented, and costs of adverse events were based on CPT codes.

The study found that, the year before the OCT system was obtained, 411 FAs were performed on 314 patients, with an average of 1.3 tests per patient, at a cost of $297,498. The year after the OCT was obtained, 692 diagnostic imaging procedures were performed on 378 patients, with an average of 1.8 tests per patient, at a cost of $325,695 (336 FAs at $243,210, and 356 OCTs at $82,485). This resulted in an increase in total diagnostic testing of 68% and an increase in total cost of only 9.5% from the year before. The researchers also looked at adverse events, noting that they occur with FA, but not with OCT. The year before the OCT system was acquired by the VA, 3 adverse events occurred with FAs (0.73), at a cost of $688 per 100 patients. The year after the OCT system was acquired, 2 adverse events occurred with FA (0.60 adverse events per 100 patients), at a cost of $421 per 100 patients. As expected, no adverse events occurred with OCT. Subgroup analyses for patients with macular edema and AMD yielded similar findings.

The findings suggest that the introduction of OCT led to a dramatic increase in the number of the procedures performed. The researchers concluded that this increase improved patient care for macular diseases, increased available diagnostic testing for patients, and decreased the risk for adverse events associated with FA. Acquiring the OCT system led to a substantial relative cost savings compared with FA alone, and the purchase price of the system was recovered within 4 months of its acquisition.

"The VA is charged with providing the highest possible care at the most reasonable cost. OCT and FA are complementary tests. OTC is quick, and there are no adverse effects, but some VA locations don't have the budget to justify offering this procedure. They end up sending their patients to us in Boston," lead author Donny L. Chang, a fourth-year medical student at the Boston University School of Medicine, told Medscape Ophthalmology.

"With this study, we thought we would show that if smaller VAs had OCT, they could evaluate patients and then send them to larger institutions for FA for tertiary care if needed," he said.

The study did not receive commercial support. The authors have disclosed no relevant financial relationships.

Association for Research in Vision and Ophthalmology 2008 Annual Meeting, Abstract 1860, April 28, 2008.

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