The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus

Abstract

Objective To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy. Design Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population. Results Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years (QALYs) by 0.008 (95% credible interval [CrI], 0.005–0.011) and increased costs by $94 (95% CrI, −$35 to $222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and $12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective. Conclusions The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, a new policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective.

Mild Visual Impairment and Its Impact on Self-Care Among Older Adults

“…The US Preventive Services Task Force recently stated there was insufficient evidence to assess the harms and benefits of screening for impaired visual acuity in older adults; however in their review of the current evidence they did find consistent evidence that screening for visual acuity can identify individuals with refractive error (Siu et al, 2016). While the effectiveness of screening for vision impairment in primary care is still to be determined, dilated eye evaluations have been found to be more cost effective than standard vision tests during an initial preventive physical examination upon enrollment in Medicare (Rein et al, 2012). Future research should examine the both the effectiveness and cost-effectiveness of screening for visual acuity and providing low cost corrective lenses, as well as consider which services will be reimbursed by insurance.…”

An evaluation of a community-based vision care programme for the elderly

“…A previous study estimated that the global cost of establishing and operating educational and refractive care facilities to deal with VI resulting from uncorrected refractive error was far below the global loss in productivity associated with that VI [ 14 ]. Another study reported that a dilated eye evaluation was cost-effective when compared to no screening [ 15 ].…”

The Economics of the Initial Preventive Physical Examination in Medicare

“…Even though our original recommendation of positioning the sutures 1 mm from the limbus to simulate an iris diaphragm does place the sutures in the same plane, 1 their modification helps ensure their alignment. Silicone oil retention sutures can be placed in different patterns depending on the exact pathology without sacrificing their ability to prevent silicone oil endothelial touch.…”