Is virtual reality training for resident cataract surgeons cost effective?

Abstract

Dear Editor, Virtual reality (VR) simulation is a promising modality to help ophthalmology residents bridge the gap between the wet lab and the operating room (OR) [1]. However, more widespread implementation of VR simulation in ophthalmology graduate medical education (GME) programs has been limited by concerns about simulator realism fidelity, lack of evidence for surgical skills transfer (VR-to-OR), and startup costs [2]. While current research is focused on addressing simulation fidelity and skills transfer, little has been done to address cost; VR units must be cost effective for VR to become a widespread part of ophthalmology GME [3, 4]. To this end, we investigated potential cost savings of VR training in cataract surgery using the criterion of reduced trainee OR time, one of the only published outcomes of VR-to-OR training [3]. The calculation of cost savings with the use of the VR simulator in residency program is summarized in Table 1. We found that the average US residency program will save $4,980 per year in non-supply costs. In addition, a well-studied VR cataract surgery simulator, the EyeSi (VRmagic, Mannheim, Germany) [1–3], costs approximately $167,000 (pers. comm., VRmagic US Sales representative, 1/07/2013); based on non-supply cost savings, it thus would require an estimated 34 years ($167,070/$4,980) for a typical US residency program to recoup the expense of a VR unit. This analysis has several limitations. First, the cost calculation was based on data from one US Veterans Health Administration (VHA) hospital. While the VHA is the largest provider of health care training in the US, costs in other teaching hospitals may differ. Second, we only evaluated non-supply costs of OR staff salaries, wages, and benefits. These were the only costs that could be readily linked to decreased OR time, as other differences in OR performance have not yet been found. Third, the estimates of savings in OR times were based on one study of 20 residents. Lastly, we only considered savings accrued with VR training in cataract surgery. While a VR training module in vitreoretinal surgery is available at additional cost, US residents only perform an average of 6.5 vitreoretinal procedures as primary surgeon in the course of their training [6]. The low volume of vitreoretinal surgery would be a significant barrier to determining the impact of VR training on resident vitreoretinal surgical outcomes and OR costs. Similarly, low volume would be a barrier for assessing the impact of VR cataract surgery training on other intraocular procedures such as glaucoma surgery. B. K. Young : P. B. Greenberg Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, RI, USA