AN INVESTIGATION OF THE HOSPITAL CHARGES RELATED TO THE TREATMENT OF ENDOPHTHALMITIS IN THE ENDOPHTHALMITIS VITRECTOMY STUDY

Purpose: The purpose of the study is to assess the hospital charges as sociated with the treatment of endophthalmitis using a sample of patie nts from the Endophthalmitis Vitrectomy Study (EVS). Methods: The Endo phthalmitis Vitrectomy Study was a multicenter, randomized clinical tr ial with a two-by-two factorial design to compare immediate pars plana vitrectomy to tap-biopsy and to compare the use of systemic antibioti cs (intravenous) to no intravenous antibiotics in the management of po stoperative endophthalmitis. Hospital charge data were collected retro spectively from 129 patients from the 4 clinical centers participating in this ancillary study. This represents 31% of the total Endophthalm itis Vitrectomy Study population. An analysis of variance was used to compare hospital charges across center and treatment. A charge-effecti veness analysis compared measures the effectiveness across treatment g roups. The annual savings of hospital charges in the United States was estimated for a range of annual incidence rates of endophthalmitis. R esults: The use of intravenous antibiotics significantly increased hos pital charges. Patients undergoing vitrectomy had significantly higher hospital charges than did patients undergoing tap-biopsy. The most ch arge-effective treatment for patients presenting with light perception only vision was immediate vitrectomy, whereas the most charge-effecti ve treatment for patients presenting with better vision was tap-biopsy . Factors other than treatment independently associated with hospital charges were female sex, history of diabetes, symptom of red eye, and baseline vision of light perception only. Conclusions: Assuming the re sults of the Endophthalmitis Vitrectomy Study were used as a guide for the treatment of endophthalmitis, the estimated annual nationwide red uction of hospital charges would be between $7.6 million and $40.0 mil lion.