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19-01-2012 | Legal medicine | Article

Dilated eye exams more cost-effective than Medicare visual acuity screening


Free abstract

MedWire News: The current Welcome to Medicare eye evaluation policy of visual acuity screening among persons with no diagnosed diabetes mellitus or eye diseases is a "suboptimal use of resources," say US researchers.

They suggest that replacing this policy with coverage of a dilated eye evaluation would be "highly cost-effective."

Visual acuity screening is performed in all US patients who enroll in the Welcome to Medicare health insurance program after turning 65 years of age. Medicare currently reimburses enrollees during their initial preventive primary care health check, but it has been suggested that dilated eye evaluations may be a more cost-effective policy.

To investigate, David Rein (University of Chicago, Illinois) and colleagues estimated the cost-effectiveness of visual acuity screenings performed in the primary care setting, and dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed diabetes mellitus or eye disorders.

The team used a Monte Carlo cost-effectiveness simulation model with a total of 50,000 simulated patients whose demographic characteristics were matched to people 65 years of age.

The findings were reported in the Archives of Ophthalmology.

Compared with a no-screening policy, dilated eye examinations during a patient's first year of Medicare eligibility would generate approximately 0.009 quality-adjusted life years (QALYs) per person, or the equivalent of 2.77 healthy days of life. This would be at a cost of US$ 94 (€ 73) per patient.

By contrast, visual acuity screening increased QALYs in less than 95% of the simulations and increased total costs by US$ 32 (€ 25).

The incremental cost-effectiveness ratio of eye examinations compared with visual acuity screenings was US$ 3400 (€ 2634), US$ 5300 (€ 4106), and US$ 9500 (€ 7360) per QALY gained from the patient, Medicare, and societal perspective, respectively. "Eye evaluations extendedly dominated visual acuity screenings," remark Rein et al.

They say that, from the societal perspective, the non-screening scenario was the most likely to be cost-effective up to a willingness to pay (WTP) value of US$ 15,000 (€ 11,622) per QALY gained. After this, eye evaluations were preferred. "There were no WTP values at which a visual acuity screening was the most likely to be cost-effective."

The team concludes: "Our research suggests that the current policy of visual acuity screening is a suboptimal use of resources and that replacing this policy with coverage of a dilated eye evaluation for all healthy patients entering Medicare would be highly cost-effective."

By Nikki Withers

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