OBJECTIVES: 225,000 vitrectomy surgeries are performed annually in the U.S. A time-driven, cost analysis conducted at a US academic hospital found the average true cost of routine vitrectomies (including macular hole (MH) surgeries) is $7,169.79 per patient, $2,000 above CMS’s 2019 reimbursed rate. MHs present as a defect near the center of the retina, resulting in significant vision impairment, requiring exceptional precision and delicacy during the procedure. A study conducted with surgical fellows in India found that the MH closure rate was significantly (p<0.004) higher in the 3D heads-up display (3D-HUD) group (86.3%) than that of the conventional microscope group (60.3%). This analysis aims to quantify the potential cost impact of improved MH closure rates using a 3D-HUD system at a US academic hospital.

METHODS: A focused literature review was conducted to identify model inputs. Relevant costs and clinical inputs were based on published literature, where available, and 2023 reimbursement rates reported by the Center for Medicare and Medicaid Services fee schedule. Costs are reported in 2023 US dollars. The cost impact was assessed as the rate of improved MH closures using the 3D-HUD system and the difference between the reimbursed rate for a MH re-closure and the true cost of a routine vitrectomy surgeries.

RESULTS: The use of the 3D-HUD system in 100 hypothetical MH closure cases by surgical fellows demonstrated cost savings of $121,853 for a US academic hospital. Savings were driven by a reduction in the number of failed MH surgeries that would require a repeat procedure.

CONCLUSIONS: In addition to potential clinical benefits, results from this cost analysis suggest use of the 3D-HUD system in patients requiring a MH closure may result in cost-savings for US academic hospitals. However, future studies assessing the true cost of MH surgeries are warranted.