Value-based medicine and ophthalmology: an appraisal of cost-utility analyses.

PURPOSE To ascertain the extent to which ophthalmologic interventions have been evaluated in value-based medicine format. METHODS Retrospective literature review. Papers in the healthcare literature utilizing cost-utility analysis were reviewed by researchers at the Center for Value-Based Medicine, Flourtown, Pennsylvania. A literature review of papers addressing the cost-utility analysis of ophthalmologic procedures in the United States over a 12-year period from 1992 to 2003 was undertaken using the National Library of Medicine and EMBASE databases. The cost-utility of ophthalmologic interventions in inflation-adjusted (real) year 2003 US dollars expended per quality-adjusted life-year (dollars/QALY) was ascertained in all instances. RESULTS A total of 19 papers were found, including a total of 25 interventions. The median cost-utility of ophthalmologic interventions was 5,219 dollars/QALY, with a range from 746 dollars/QALY to 6.5 million dollars/QALY. CONCLUSIONS The majority of ophthalmologic interventions are especially cost-effective by conventional standards. This is because of the substantial value that ophthalmologic interventions confer to patients with eye diseases for the resources expended.

[1]  R. Robinson.  Economic Evaluation and Health Care Cost-effectiveness analysis , 2006 .

[2]  Sanjay Sharma.  LEVELS OF EVIDENCE , 2007 .

[3]  J P Kassirer,et al.  Incorporating patients' preferences into medical decisions. , 1994, The New England journal of medicine.

[4]  R. Robinson,et al.  Economic Evaluation and Health Care Cost-utility analysis , 2006 .

[5]  Gary C. Brown,et al.  Health care economic analyses and value-based medicine. , 2003, Survey of ophthalmology.

[6]  S. Satya‐Murti.  Evidence-based Medicine: How to Practice and Teach EBM , 1997 .

[7]  J. Javitt,et al.  Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity. , 1993, Pediatrics.

[8]  Gary C. Brown,et al.  The Quality of Life of Patients With Hypertension , 2002, Journal of clinical hypertension.

[9]  Gary C. Brown,et al.  A cost-utility analysis of interventions for severe proliferative vitreoretinopathy. , 2002, American journal of ophthalmology.

[10]  G. Brown,et al.  Value based medicine , 2004, British Journal of Ophthalmology.

[11]  Gary C. Brown,et al.  Cost-utility analysis of cataract surgery in the second eye. , 2003, Ophthalmology.

[12]  Wayne F. Cascio,et al.  Managing Human Resources , 1989 .

[13]  T O Tengs,et al.  Health-related quality of life after stroke a comprehensive review. , 2001, Stroke.

[14]  Gary C. Brown,et al.  THE VALUE COMPONENT OF EVIDENCE-BASED MEDICINE , 2000 .

[15]  H. Fineberg,et al.  Preferences for Health Outcomes , 1984, Medical decision making : an international journal of the Society for Medical Decision Making.

[16]  A S Detsky,et al.  How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. , 1992, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[17]  Gary C. Brown,et al.  Quality of life associated with visual loss: a time tradeoff utility analysis comparison with medical health states. , 2003, Ophthalmology.

[18]  A. Zbrozek,et al.  Model of Complications of NIDDM: II. Analysis of the health benefits and cost-effectiveness of treating NIDDM with the goal of normoglycemia , 1997, Diabetes Care.

[19]  E. Quah,et al.  Cost-Benefit Analysis , 1972 .

[20]  G. Brown,et al.  Difference between ophthalmologists' and patients' perceptions of quality of life associated with age-related macular degeneration. , 2000, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[21]  R. Hayward,et al.  Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus. , 2000, JAMA.

[22]  A F Smith,et al.  Understanding cost effectiveness: a detailed review , 2000, The British journal of ophthalmology.

[23]  G. Brown,et al.  Vision and quality-of-life. , 1999, Transactions of the American Ophthalmological Society.

[24]  R. Chaisson,et al.  Cost-utility analysis of prophylactic treatment with oral ganciclovir for cytomegalovirus retinitis. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[25]  G. Brown,et al.  The cost-effectiveness of photodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. , 2001, Ophthalmology.

[26]  Tammy O. Tengs,et al.  One thousand health-related quality-of-life estimates. , 2000, Medical care.

[27]  M. Angell.  Patients' preferences in randomized clinical trials. , 1984, The New England journal of medicine.

[28]  Gary C. Brown,et al.  Outcome of corneal transplantation , 2002, The British journal of ophthalmology.

[29]  G. Brown,et al.  The cost-effectiveness of grid laser photocoagulation for the treatment of diabetic macular edema: results of a patient-based cost-utility analysis. , 2000, Current opinion in ophthalmology.

[30]  Gary C. Brown,et al.  Quality of life with visual acuity loss from diabetic retinopathy and age-related macular degeneration. , 2002, Archives of ophthalmology.

[31]  D. Sackett.  Evidence-based medicine: how to practice and teach EBM: 2nd ed , 2000 .

[32]  Gary C. Brown,et al.  The cost-effectiveness of early vitrectomy for the treatment of vitreous hemorrhage in diabetic retinopathy , 2001, Current opinion in ophthalmology.

[33]  Nix Je.  Medicare fee schedule. , 1990 .

[34]  Gary C. Brown,et al.  CME REVIEW: A COST‐UTILITY ANALYSIS OF LASER PHOTOCOAGULATION FOR EXTRAFOVEAL CHOROIDAL NEOVASCULARIZATION , 2003, Retina.

[35]  M. Weinstein,et al.  Identifying and Valuing Outcomes , 1996 .

[36]  J P Kassirer,et al.  Adding insult to injury. Usurping patients' prerogatives. , 1983, The New England journal of medicine.

[37]  R L Kane,et al.  Methodology for measuring health-state preferences--I: Measurement strategies. , 1989, Journal of clinical epidemiology.

[38]  David B. Balkin,et al.  Managing human resources , 1982 .

[39]  Gary C. Brown,et al.  Cost-Effectiveness of Treatment for Threshold Retinopathy of Prematurity , 1999, Pediatrics.

[40]  Gary C. Brown,et al.  Incremental cost-effectiveness of initial cataract surgery. , 2002, Ophthalmology.

[41]  M A Koopmanschap,et al.  Analysis of costs and cost-effectiveness in multinational trials. , 2001, Health policy.

[42]  DIFFERENCE BETWEEN OPHTHALMOLOGISTS' AND PATIENTS' PERCEPTIONS OF QUALITY OF LIFE ASSOCIATED WITH AGE-RELATED MACULAR DEGENERATION , 2000 .

[43]  Gary C. Brown,et al.  Patient, community and clinician perceptions of the quality of life associated with diabetes mellitus. , 2002, Medical science monitor : international medical journal of experimental and clinical research.

[44]  R. Centor,et al.  What is heartburn worth? A cost-utility analysis of management strategies. , 2000, Journal of general internal medicine.

[45]  S. Wilson.  Methods for the economic evaluation of health care programmes , 1987 .

[46]  Gary C. Brown,et al.  A cost-utility analysis of therapy for amblyopia. , 2002, Ophthalmology.