In reply
We appreciate the interest of Drs Fitzgerald-Shelton and Higginbotham in our article. Obviously, in this era of managed care and cost containment, physicians need to be cognizant of operating costs. However, their comments regarding differential implant cost do not address the topic of total operating costs when implanting either of these glaucoma drainage setons.Usually, the extra dissection to implant a double-plate Molteno takes about 20 additional minutes. Many operating rooms charge more than $20 per minute for each additional half hour of operating time after an initial base time (personal communication with Department of Cost, Price, and Reimbursement, Shands Hospital, Gainesville, Fla, February 1996). Thus, the total cost of a double-plate Molteno implant might be $136 more ($335 for the Molteno double-plate implant plus $400, assuming an additional 20 minutes of operating time) than the cost of a Baerveldt implant ($599).Last, we rarely implant single-plate Molteno