Procedures, Visits, and Procedure Costs in the Management of Microbial Keratitis

Abstract

Purpose: To investigate the burden of procedures, visits, and procedure costs in the management of microbial keratitis (MK). Methods: Medical records of patients from an academic hospital outpatient facility between December 2013 and May 2018 were retrospectively reviewed. Patients were included if they were older than the age of 18 years, recruited for study of likely MK, and not concurrently undergoing treatment for other acute eye conditions. For procedural costs, Medicare data for billing were obtained using the Center for Medicare and Medicaid Services Physician Fee Lookup tool. Results: A total of 68 patients were included for analysis. Patients were on average 51.3 years (SD = 19.5), 55.9% women (n = 38), and 89.7% White (n = 61). Per person, the average number of procedures was 2.9 (SD = 4.2). The average number of visits was 13.9 (SD = 9.2) over an average of 26.9 weeks (SD = 24.3). Age (P < 0.0001), positive Gram stain (P = 0.03), and mixed Gram stain (P = 0.002) were positively associated with the number of procedures. Age (P = 0.0003), fungal keratitis (P = 0.02), and mixed Gram stain (P = 0.01) were positively associated with the number of visits. Race was inversely associated with the number of procedures (P = 0.045) and visits (0.03). Patients with bacterial keratitis were more likely to have amniotic membrane grafts (P = 0.01) and tarsorrhaphies (P = 0.03) than fungal patients. Across all procedures performed for the management of MK, the mean cost per patient was $1788.7 (SD = $3324.62). Conclusions: Patients incur many procedural costs and attend many visits during the management of MK. These findings emphasize the importance of patient–provider communication for frequent follow-up care and the potential need to perform procedures for disease management.

Spectrum and resistance in bacterial infections of the ocular surface in a German tertiary referral center 2009–2019

“…In our study, as well as in the comparable literature, females and males were relatively equally distributed in the overall cohort [ 12 , 15 , 21 , 22 , 26 – 28 , 38 ]. However, while we found sex-specific differences for Enterobacterales, Pseudomonas, and Staphylococcus aureus , in the other studies, no such difference was identified [ 12 , 15 , 21 , 22 , 26 – 28 , 38 ].…”

Epidemiology and Economic Cost Analysis of Microbial Keratitis from a Tertiary Referral Hospital in Australia

“…A significant proportion of these patients are admitted to hospital to assist in adherence to intensive topical antimicrobial therapy and enable closer monitoring. Cost evaluation of MK in the international literature is lacking with limited studies from the UK, USA, Taiwan and India [ 13 , 14 , 15 , 16 , 17 ]. The mean cost of procedural treatment from 2013–2018 for a patient with MK in the USA was estimated to be USD 1788.7 and in the UK as GBP 2855 (USD 3252) [ 14 , 16 ].…”

“…Cost evaluation of MK in the international literature is lacking with limited studies from the UK, USA, Taiwan and India [ 13 , 14 , 15 , 16 , 17 ]. The mean cost of procedural treatment from 2013–2018 for a patient with MK in the USA was estimated to be USD 1788.7 and in the UK as GBP 2855 (USD 3252) [ 14 , 16 ]. Due to the differences in healthcare systems and methodologies used, costs reported in previous studies vary widely.…”

Therapy for contact lens-related ulcers

“…Contact lens-related microbial keratitis (CLMK) is a serious, sight-threatening problem with an estimated rate of two to four per 10 000 contact lens wearers per year [1 ▪ ]. CLMK results in an enormous economic burden due to frequent clinic visits and the cost of medications and procedures [1 ▪ ,2,3]. Contact lenses increase the risk for keratitis by acting as a microbial nidus and breaking down the corneal epithelium to provide an entryway for pathogens.…”