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Cost-efficiency of endoscopic and external dacryocystorhinostomy

Published online by Cambridge University Press:  19 July 2007

S Anari ,
G Ainsworth  and
A K Robson
S Anari*
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Carlisle, UK
G Ainsworth
Affiliation:
Department of Ophthalmology, Cumberland Infirmary, Carlisle, UK
A K Robson
Affiliation:
Department of Otolaryngology/Head and Neck Surgery, Carlisle, UK
*
Address for correspondence: Mr Shahram Anari, 33 Thornbury Close, Newcastle upon Tyne NE3 2FD, UK. E-mail: sssanari@yahoo.co.uk
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Abstract

Background:

In most centres in the United Kingdom, endoscopic dacryocystorhinostomy is currently undertaken as a joint operation between ophthalmologists and otolaryngologists. The addition of an extra surgeon, the use of endoscopic equipment and the relatively lower success rate of this procedure made us compare endoscopic dacryocystorhinostomy and external dacryocystorhinostomy with regards to costs and income for our hospital.

Methods:

All 38 primary endoscopic dacryocystorhinostomy cases performed in our centre in 2001–2003 were retrospectively compared with the 49 external dacryocystorhinostomy cases performed in 1993–2000. Cost–income calculations were made based on: rate of local anaesthesia, success rate, rate of day case admission, hospital reference cost for dacryocystorhinostomy, and the income per case extracted from national tariffs (based on the Health Resources Group). Also, the average number of cases per session was used to calculate the income gained per session for each method.

Results:

The following rates between the endoscopic and the external dacryocystorhinostomy were found: local anaesthesia, 29 vs 6 per cent, respectively; day-case operation, 95 vs 12 per cent, respectively; and success rate, 87 vs 94 per cent, respectively. The average number of endoscopic dacryocystorhinostomy cases conducted in a single theatre session was twice that of external dacryocystorhinostomy cases. Endoscopic dacryocystorhinostomy generated approximately twice the income of external dacryocystorhinostomy (£6585 vs £3292, respectively).

Conclusion:

Endoscopic dacryocystorhinostomy is more cost-effective than external dacryocystorhinostomy, despite having a lower success rate and greater usage of resources, as the endoscopic procedure generates more income. This is mainly due to the higher number of cases per session and the higher rates of local anaesthesia and day case operations possible.

Keywords

Lacrimal Apparatus DiseasesEndoscopesOtorhinolaryngologic Surgical ProceduresCost Benefit Analysis
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 5 , May 2008 , pp. 476 - 479
Copyright
Copyright © JLO (1984) Limited 2007

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