The Quality Adjusted Life Year: A Total-Utility Perspective

Firth, Steven J.

doi:10.1017/s0963180117000615

Cited by 5 publications

(6 citation statements)

References 13 publications

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“…A cost/QALY threshold of $50,000 is frequently cited in the literature, although Neumann et al have argued that this is too low of a threshold in the United States, with $100,000 or $150,000 as more reasonable estimates. 36 , 44 From a DR and DME treatment perspective, the program met Neumann et al’s cost/QALY threshold of $100,000, while the $50,000 threshold was met when treatment for non-retinal disease was included. 44 While Maberley et al’s study had one fourth the cost/QALY as compared to our study, they had a greater proportion of patients treated and half the screening cost.…”

Section: Discussionmentioning

confidence: 99%

“…The second approach was to calculate the number of Quality Adjusted Life Years (QALYs) saved. 36 The incremental QALYs saved by treatments were obtained from the literature in order to standardize the results and avoid potential bias from non-ophthalmologic comorbidities. The QALYs saved are shown in Table 1 with corresponding references in parentheses.…”

Section: Methodsmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…Our study did not detect cost-effectiveness using the traditional methods with cost/clinical outcomes or cost/ quality-adjusted life-year (QALY), because different individuals have different subjective values for health benefits. 28 For skin conditions with the rare risk of disability or death, WTP can reflect the preferences and disease burden in a monetary manner, which may be more accurate and direct in detecting BCA compared with the traditional tools. In the past, there are a few studies that used WTP method to obtain the BCA for a specific treatment in the field of dermatology.…”

Section: Discussionmentioning

confidence: 99%

<p>Willingness-to-Pay and Benefit–Cost Analysis of IPL for Rosacea Treatment: A Cross-Sectional Study in China</p>

Deng¹,

Zhang²,

Deng³

et al. 2020

PPA

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Background: Intense pulsed light (IPL), as a therapeutic approach for rosacea, had advantage in removing erythema and telangiectasia and was gradually accepted by rosacea patients, but there have been few studies on economic evaluation of this therapy. Purpose: This study aimed to detect willingness-to-pay (WTP) of IPL treatment for rosacea and to conduct a benefit-cost analysis (BCA) among the Chinese population, so as to provide an economic reference for doctors to make treatment decisions. Materials and Methods: An observational, cross-sectional study assessed respondent's demographic characteristics and willingness-to-pay (WTP) of IPL and rosacea patients' clinical data and Dermatology Life Quality Index (DLQI). WTP was obtained by contingent valuation (CV) method. In brief, contrast figures of three cases treated with IPL (Case1, Case2, and Case3 represented the increasing severity of rosacea) were showed and WTP was inquired. The costs were obtained according the market and compared with WTP (benefits) to get a benefit-cost ratio (BCR). Predictors of cost-effective WTP were identified using the multivariable logistic regression model. Results: A total of 303 rosacea patients and 202 controls were included in the study. The average cost of a single IPL treatment for rosacea was USD 208.04 in Changsha, China. The mean WTP for Case 1, Case 2, and Case 3 was USD 201.57, 214.64, and 221.74, respectively. WTP was statistically lower for Case 1 than that for Case 2 or Case 3 (P<0.05). The BCRs were 0.85, 1.03, and 1.06 for Case 1, Case 2, and Case 3, respectively. WTP is significantly associated with household monthly income, previous treatment cost, and DLQI after adjustments for demographic characteristics (P<0.05). Conclusion: IPL is an acceptable treatment for rosacea with moderate to severe erythema. For patients with relatively high income or severely impaired quality of life, IPL is an economically feasible therapy and deserves to be recommended.

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“…Accordingly, healthcare can be thought of as a sort of potential utility. 8 A welfare-funded sexual needs service would be akin to sports rehabilitation or femoral artery replacement in that they all respond to the decrease in a person’s quality of life as a function of a reduction in well-being.…”

Section: On Positive Sexual Rightsmentioning

confidence: 99%

Whither a Welfare-Funded ’Sex Doula' Programme?

Firth

2019

J Med Ethics

Self Cite

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The sexual citizenship of disabled persons is an ethically contentious issue with important and broad-reaching ramifications. Awareness of the issue has risen considerably due to the increasingly public responses from charitable organisations which have recently sought to respond to the needs of disabled persons—yet this important debate still struggles for traction in academia. In response, this paper continues the debate raised in this journal between Appel and Di Nucci, concurring with Appel’s proposals that sexual pleasure is a fundamental human right and that access to sexual citizenship for the severely disabled should be publicly funded. To that endeavour, this paper refutes Di Nucci’s criticism of Appel’s sex rights for the disabled and shows how Di Nucci’s alternative solution is iniquitous. To advance the debate, I argue that a welfare-funded ‘sex doula' programme would be uniquely positioned to respond to the sexual citizenship issues of disabled persons.

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The Quality Adjusted Life Year: A Total-Utility Perspective

Cited by 5 publications

References 13 publications

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

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

<p>Willingness-to-Pay and Benefit–Cost Analysis of IPL for Rosacea Treatment: A Cross-Sectional Study in China</p>

Whither a Welfare-Funded ’Sex Doula' Programme?

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