title: Comparison of acquisition costs of surgical supplies in different health care systems for cataract and glaucoma procedures.
abstract: OBJECTIVE
  To determine cost identification and acquisition cost comparison of surgical supplies for performing cataract and glaucoma procedures.
  
  
  METHODS
  This is a nonrandomized comparative and cross-sectional study. Six health care systems [state-run charity hospital, a private university hospital, 2 ambulatory surgical centers (ASCs), and 2 Veterans Affairs Medical Centers] participated in the study. A list of input prices for disposable surgical items necessary for phacoemulsification with intraocular lens and for trabeculectomy with mitomycin-C (MMC), Ex-PRESS shunt placement, and Ahmed glaucoma valve (AGV) with scleral patch graft was administered to 6 facilities. The total acquisition costs for each surgery at each facility was calculated as the sum of necessary items' costs. All costs are expressed in 2011 US dollars. Total acquisition costs for phacoemulsification/intraocular lens, trabeculectomy with MMC, Ex-PRESS shunt and AGV with scleral patch graft implantation in different health care settings were the main outcome measures.
  
  
  RESULTS
  The state-run hospital had the highest overall cost of disposable items for both cataract surgery ($648) and trabeculectomy with MMC ($339), whereas the Veterans Affairs Medical Centers had the lowest acquisition costs for cataract ($386) and the ASC ($96) for trabeculectomy. The ASC system had the lowest cost for both Ex-PRESS shunt ($707) and AGV ($865), whereas the University ($1352 for the Ex-PRESS) and the state ($1338 for AGV) had the highest cost. Average difference between total disposable item acquisition costs and Medicare payment after different surgeries per case is as follows: $544.29 for cataract surgery, $1834.50 for trabeculectomy, $763.30 for Ex-PRESS shunt, and $1315.00 for the AGV surgery.
  
  
  CONCLUSIONS
  The ASC system had the lowest acquisition cost for disposable items for both cataract and glaucoma surgeries, whereas the university hospital and the state hospital carried the highest costs on an average. Among the 3 glaucoma procedures compared, trabeculectomy has the lowest acquisition costs for disposable items.
authors.affiliation: *Department of Ophthalmology, Tulane School of Medicine, Tulane University, New Orleans, LA †Department of Anesthesia and Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Valentine
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Ramesh S
authors.initials: RS
authors.lastname: Ayyala
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics; D002386:Cataract / Q000191:economics*; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004209:Disposable Equipment / Q000191:economics; D005901:Glaucoma / Q000191:economics*; D020327:Glaucoma Drainage Implants / Q000191:economics*; D006783:Hospitals, State / Q000191:economics; D006785:Hospitals, University / Q000191:economics; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D007910:Lenses, Intraocular / Q000191:economics*; D008875:Middle Aged; D018918:Phacoemulsification / Q000191:economics* / Q000295:instrumentation; D014130:Trabeculectomy / Q000191:economics* / Q000295:instrumentation; D016896:Treatment Outcome