Opportunities to Reduce Potential Bias in Ophthalmic Cost-Utility Analysis

Brown, Gary C.; Brown, Melissa M.; Chaudhry, Imtiaz A.; Stein, Joshua D.

doi:10.1001/jamaophthalmol.2020.6591

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…The QALYs saved are shown in Table 1 with corresponding references in parentheses. 25 , 37 , 38 Note that the value of 0.18 for DME and PDR was obtained by using an estimate of 0.77 QALY for persons living with diabetes without any DR or DME and 0.59 for patients with PDR or DME. 23 …”

Section: Methodsmentioning

confidence: 99%

The Cost-Effectiveness of a Telemedicine Screening Program for Diabetic Retinopathy in New York City

Muqri¹,

Shrivastava²,

Muhtadi³

et al. 2022

OPTH

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Background A telemedicine screening initiative was implemented by the Montefiore Health System to improve access to eyecare for a multi-ethnic, at-risk population of diabetic patients in a largely underserved urban community in the Bronx, New York. This retrospective, cross-sectional analysis evaluates the societal benefit and financial sustainability of this program by analyzing both cost and revenue generation based on current standard Medicare reimbursement rates. Methods Non-mydriatic fundus cameras were placed in collaboration with a vendor in eight outpatient primary care sites throughout the Montefiore Health Care System, and data was collected between June 2014 and July 2016. Fundus photos were electronically transmitted to a central reading center to be systematically reviewed and coded by faculty ophthalmologists, and patients were subsequently scheduled for ophthalmic evaluation based upon a predetermined treatment algorithm. A retrospective chart review of 2251 patients was performed utilizing our electronic medical record system (Epic Systems, Verona WI). Revenue was projected utilizing standard Medicare rates for our region while societal benefit was calculated using quality adjusted life years (QALY). Results Of the 2251 patient charts reviewed, 791 patients (35.1%) were seen by Montefiore ophthalmologists within a year of the original screening date. Estimated revenue generated by these visits was $276,800, with the majority from the treatment of retinal disease ($208,535), and the remainder from other ophthalmic conditions detected in the fundus photos ($68,265). There was a societal benefit of 14.66 quality adjusted life years (QALYs) with an estimated value of $35,471/QALY. Conclusion This telemedicine initiative was successful in identifying many patients with diabetic retinopathy and other ophthalmic conditions who may otherwise not have been formally evaluated. Our analysis demonstrates the program to generate a downstream revenue of nearly $280K with a cost benefit below <50% of the threshold of $100,000/QALY, and therefore cost-effective in marginalized communities.

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Section: Methodsmentioning

confidence: 99%

The Cost-Effectiveness of a Telemedicine Screening Program for Diabetic Retinopathy in New York City

Muqri¹,

Shrivastava²,

Muhtadi³

et al. 2022

OPTH

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“…For example, visual impairment earlier in life may impact earning potential and comparing this with later-onset visual impairment where comorbidities may exist is a complex problem. 158 Finally, this is not a cost-benefit analysis and future work should consider the cost associated with myopia control, including those associated with adverse events, along the potential savings associated with any reduction in ocular morbidity. Nonetheless, some brief comment is warranted.…”

Section: Limitations Of Modelmentioning

confidence: 99%

“…For example, other authors apply an upper limit of $100,000 per QALY and consider the difference between 20/20 and 20/40 to represent 0.12 QALYs. 158 The costs associated with myopia control are also challenging to estimate. At the time of writing only one device or drug is FDA-approved for myopia control in the US and was only launched in the past year, although it has been available in other countries for some years.…”

Section: Limitations Of Modelmentioning

confidence: 99%

The Risks and Benefits of Myopia Control

et al. 2021

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“…In this issue of JAMA Ophthalmology, Brown et al 5 set out to answer this question by calculating cost-utility values for treatment of cataracts and NVAMD (phacoemulsification and intravitreal injections of ranibizumab for 11 years, respectively) using settings in the US, 2018 costs, and utility values estimated using the TTO approach from patients with the conditions, patients without the conditions (ie, the general public), and medical students without exposure to ophthalmology. The issue of systemic nonophthalmic comorbidity, a condition in which other serious concurrent comorbidities affect the overall patient utility value, was addressed by using the maximum limit approach in which the systemic comorbidity utility was set as an upper limit for the potential vision utility gain associated with the ophthalmic interventions.…”

Section: Invited Commentarymentioning

confidence: 99%