"ABC" of costing of cataract surgeries.

Sir,

This refers to the Editorial commentary by Parikshit in OJO.[1] The author has attempted to compare various techniques of cataract surgery in terms of efficacy, safety, and cost. We would like to draw attention to the costing portion of the commentary. Author has cited only a single reference referring to a randomized control trial comparing phacoemulsification with extracapsular cataract extraction (ECCE) to conclude phacoemulsification to be more effective and economical in the United Kingdom (UK). Costing and cost implications of other surgical procedures for cataract have not been elaborated upon.[2]

Estimation of cost and cost-effectiveness of any surgical intervention including cataract is difficult as recurrent costs cannot be generalized.[34] There are several methods by which costing can be estimated for cataract surgeries. One of the common methods is activity-based costing (ABC) which is an accounting technique that allows an organization to determine the actual cost associated with each procedure and services provided by the organization without regard to the organizational structure. ABC methods enable managers to cut cost out measurement to business simplification and process involvement.[5] It is a management as well a financial tool and a method that suits hospital costing by its indigenous design. ABC not only provides relative accurate cost data but also information about the origin of the cost.[56]

For cataract costing the following are required.[7]

Identification of the ophthalmic process: The surgical ophthalmic process used in the surgery will contribute significantly to the overall cost as in conventional cataract surgery, small incision cataract surgery, phacoemulsification.

Cost of consumables used: Consumables like syringe, needle, drapes, dye, gloves, balanced salt solution (BSS), intraocular lens (IOL), liquids for scrubbing, and other disposable items used during surgery. A weighted average of cost after verification and validation from stores should be done for true cost estimation.

Costing of the operation theater (OT) procedures: This may include the fixed asset costs like cost of building, maintenance, equipment (phacoemulsification machine), manpower (salaries), electricity, air conditioner, water inflow, and others.

Time spent per procedure by different surgeons in different settings, e.g. public versus private set up and average time required (based on experience) should also be included in estimation of cost.

There is an urgent need for developing awareness and insight into measures to reduce the cost where ever feasible by help of modern management technique. This may help in budgetary allocation in existing setups. Simple solutions like increase in the operation theater timings may reduce the cost considerably.[5]

At present, there is a huge lack of awareness amongst policy planners, hospital administrators and hospital staff regarding the costing involved in cataract surgeries. Hence there is a need to develop cost accounting and appropriate hospital management information systems that may help in better decision making for optimal utilization of resources. Periodic costing exercise (at least yearly) should be conducted for optimal decision making and budgetary allocation.