Cost analysis of mydriasis strategies in cataract surgery care in the Netherlands

PURPOSE To investigate the economic impact of an intracameral mydriatics and anesthesic agent (ICMA), topical mydriatics, and a mydriatic ocular insert in cataract patients. SETTING One public hospital in the Netherlands. DESIGN Prospective cohort study. METHODS Resource use data were collected from a healthcare and societal perspective on the day of surgery. Other outcome parameters included pupil size, surgeon satisfaction, postoperative pain, and Catquest-9SF scores. RESULTS Mean costs per patient were O 506 in the ICMA group (n=122), O 474 in the ocular insert group (n=115), and O 451 in the topical group (n=131). The acquisition cost of ICMA was highest and resulted in longer surgical time. After correction for an imbalance in the distribution of fast and slow surgeons, mean costs in the ocular insert and topical groups were comparable (O 450 versus O 444). There was no difference in the use of additional mydriatics intraoperatively (P=0.521).The mean ratio of pupil size to white-to-white distance was lower in the ICMA group during all intraoperative measurements (P<0.001), but similar between the topical and ocular insert groups (P range 0.11-0.82). CONCLUSIONS In the investigated setting in the Netherlands, ICMA was the most costly strategy. In addition, pupil size was lowest in the ICMA group, but did not result in more additional mydriasis measures intraoperatively. The ocular insert was comparable to topical mydriatics in regard to costs and pupil size. Implementation of ICMA could be considered when availability of nurses or physical space for perioperative care is limited.