Eliminating Visual Acuity and Dilated Fundus Exams Improves Cost Efficiency of Performing OCT-Guided Intravitreal Injections.

PURPOSE The clinic efficiency and cost savings achieved by eliminating formal visual acuity (VA) and dilated fundus exams (DFEs) were assessed for established patients receiving OCT-guided intravitreal injections. DESIGN Comparative cost analysis METHODS: Two different treatment models were evaluated. The first model included patients undergoing routine VA assessment, DFEs, OCT imaging, and intravitreal injections. The second model eliminated the routine VA assessment and DFE, while utilizing OCT imaging through an undilated pupil followed by the intravitreal injection. The two models incorporated both bevacizumab and aflibercept. The number of patients per clinic day, the cost per visit, and the daily revenues were compared between the two models. RESULTS Optimized schedules with and without VA assessments and DFEs allowed for 48 and 96 patients to be injected per day, respectively. Excluding drug costs, the cost per encounter for the visits with and without a DFE were $39.33 and $22.63, respectively. Including the drug costs, the costs per encounter for the visits with and without a DFE were $85.55 and $68.85 for bevacizumab and $1,787.58 and $1,7770.88 for aflibercept, respectively. Once the reimbursements for each visit type were included, the clinics that eliminated the VA and DFEs were more cost efficient. CONCLUSIONS Eliminating both VA assessments and DFEs for patients undergoing OCT-guided retreatment with intravitreal injections resulted in decreased exposure times between patients and clinic staff, decreased cost per encounter, and increased patient volumes per clinic day, resulting in improved clinic efficiency and safety while seeing more patients in a clinic day.