Comparative Cost Analysis of Pediatric and Adult Retinal Detachment Repairs Using Time-Driven Activity-Based Costing

Purpose: To compare the costs and reimbursement rates of retinal detachment (RD) repair surgeries in pediatric vs adult patients. Methods: Current Procedural Terminology (CPT) codes for scleral buckle (67107), standard RD repair (67108), and complex RD repair (67113) from January 2017 to May 2024 were extracted. A total of 103 pediatric cases and 549 adult cases were included. A cost analysis was performed using the time-driven activity-based costing methodology. Results: For scleral buckles, total costs were not significantly different between the pediatric and adult groups ($8,884.23 vs $7,878.26, respectively; P = .14). For standard RD repair, there was a significant difference in total material costs ($1,366.71 vs $1,023.66; P = .0013), grand total costs ($8,163.56 vs $5,076.18; P < .001), and day-of-surgery time costs ($6,796.87 vs $4,087.74; P < .001) for pediatric vs adult cases, respectively. For complex RD repair, grand total costs ($10,261.2 vs $9,528; P = .14) were equivalent. Net margins of RD repair under Medicare were −$3,296.52 and −$2,323.55 for scleral buckle, −$2,568.45 and +$430.93 for standard pars plana vitrectomy (PPV) repair, and −$4,467.92 and −$3,745.72 for complex PPV repair, for pediatric and adult patients, respectively. Conclusions: Pediatric standard vitrectomy had 60.8% higher total costs compared with that of adults. There was a net margin loss for standard PPV in pediatric patients (−$2,568.45), with only 68.5% of costs covered under Medicare. Net margin losses were also observed for complex RD repairs in both pediatric (−$4,467.92) and adult surgeries (−$3,745.72), with 56.4% and 60.7% of the costs covered under Medicare, respectively. Pediatric standard vitrectomy, scleral buckle, and complex PPV had greater losses compared with adult surgeries.