As the Obama administration pushes healthcare providers to compare treatments for value and efficacy, a study of glaucoma diagnosis and care in the United States reports for the first time that current practices are cost-effective in regard to both vision quality and quality of life.
Primary-open angle glaucoma (POAG), the most common form of this potentially blinding eye disease, affects more than two million Americans annually. Many others—people with a family history of glaucoma or with elevated intraocular pressure (IOP), a known precursor—also receive screening and treatment services each year. Annual POAG-related health care costs now exceed $3 billion. David B. Rein, PhD, RTI International, collaborated on the study with researchers from the United States Centers for Disease Control and Prevention (CDC), Duke University and Harvard University. The study was funded by the CDC.
The researchers used a computer model to simulate assessment and treatment of POAG for 20 million people, tracked from age 50 to 100 (or death). Simulated participants were assigned ethnicities, gender, and life expectancy based on 2004 U.S. population data, and assigned active POAG, elevated IOP, and other relevant health conditions based on widely-accepted prevalence data. Patients diagnosed and treated for POAG were compared with people who were not assessed or treated. Care standards were drawn from the Academy’s Preferred Practice Pattern (PPP), used by U.S. and international ophthalmologists.
With no treatment a person with POAG would experience 5.2 years of visual impairment or blindness, on average, compared with 2.6 years for patients with treatment assumed to be conservatively effective. The peak age group for visual impairment and blindness was 75 to 79; with no treatment, 24.6 percent of people would have significant loss of vision, versus 12.1 percent (conservative efficacy) or 4.8 percent (optimistic efficacy) for treated patients.
Cost-effectiveness calculations included ophthalmic costs, nursing home costs attributable to vision problems, and total costs, as well as per-person Quality-Adjusted Life Years (QALY) and years of unimpaired vision. QALY is a multi-factor formula used by researchers to measure a person’s health improvement, general functionality and well-being following a medical intervention and is factored over the person’s estimated remaining years of life. The lower the dollar amount calculated for a QALY, the higher the value of the intervention. Compared with no treatment, routine POAG care cost $46,000 per QALY gained (conservative) or $28,000 per QALY gained (optimistic.) These results compared favorably with World Health Organization cost-effectiveness standards.
“Current glaucoma assessment and treatment patterns are cost-effective in reducing vision loss and associated health problems, even with routine eye exam costs included,” Dr. Rein said.
This research was published in the May issue of Ophthalmology, the journal of the American Academy of Ophthalmology.
Materials provided by American Academy of Ophthalmology. Note: Content may be edited for style and length.
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