title: Direct cost of pars plana vitrectomy for the treatment of macular hole, epiretinal membrane and vitreomacular traction: a bottom-up approach.
abstract: OBJECTIVE
  The direct cost to the National Health Service (NHS) in England of pars plana vitrectomy (PPV) is unknown since a bottom-up costing exercise has not been undertaken. Healthcare resource group (HRG) costing relies on a top-down approach. We aimed to quantify the direct cost of intermediate complexity PPV.
  
  
  METHODS
  Five NHS vitreoretinal units prospectively recorded all consumables, equipment and staff salaries during PPV undertaken for vitreomacular traction, epiretinal membrane and macular hole. Out-of-surgery costs between admission and discharge were estimated using a representative accounting method.
  
  
  RESULTS
  The average patient time in theatre for 57 PPVs was 72 min. The average in-surgery cost for staff was £297, consumables £619, and equipment £82 (total £997). The average out-of-surgery costs were £260, including nursing and medical staff, other consumables, eye drops and hospitalisation. The total cost was therefore £1634, including 30 % overheads. This cost estimate was an under-estimate because it did not include out-of-theatre consumables or equipment. The average reimbursed HRG tariff was £1701.
  
  
  CONCLUSIONS
  The cost of undertaking PPV of intermediate complexity is likely to be higher than the reimbursed tariff, except for hospitals with high throughput, where amortisation costs benefit from economies of scale. Although this research was set in England, the methodology may provide a useful template for other countries.
authors.affiliation: LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK. e.m.nicod@lse.ac.uk.
authors.forename: Elena
authors.identifier: http://orcid.org/0000-0001-6798-9923
authors.initials: E
authors.lastname: Nicod
authors.affiliation: Department of Ophthalmology, School of Medicine, King's College London, London, UK.
authors.forename: Timothy L
authors.identifier: http://orcid.org/0000-0001-7618-1555
authors.initials: TL
authors.lastname: Jackson
authors.affiliation: LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
authors.forename: Federico
authors.initials: F
authors.lastname: Grimaccia
authors.affiliation: LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
authors.forename: Aris
authors.initials: A
authors.lastname: Angelis
authors.affiliation: Department of Ophthalmology, Hull and East Yorkshire Hospital, Yorkshire, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Costen
authors.affiliation: Vitreoretinal Unit, Bristol Eye Hospital, Bristol, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Haynes
authors.affiliation: Vitreoretinal Unit, Sussex Eye Hospital, Brighton, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Hughes
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Pringle
authors.affiliation: Department of Ophthalmology, Barts Health, Whipps Cross Hospital, London, UK.
authors.forename: Hadi
authors.initials: H
authors.lastname: Zambarakji
authors.affiliation: LSE Health and Social Care, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
authors.forename: Panos
authors.initials: P
authors.lastname: Kanavos
mesh_terms: D004739:England; D019773:Epiretinal Membrane; D004865:Equipment and Supplies, Hospital / Q000191:economics; D017048:Health Care Costs; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D010564:Personnel, Hospital / Q000191:economics; D012167:Retinal Perforations / Q000191:economics* / Q000601:surgery; D013222:State Medicine; D014821:Vitrectomy / Q000191:economics*
keywords: Cost; Epiretinal membrane; Macular hole; Pars plana vitrectomy; Vitreomacular traction