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Sep 2012

The Economics of the Initial Preventive Physical Examination in Medicare

Author Affiliations

Author Affiliations: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, Missouri (Dr Kymes); and Public Health Committee, American Academy of Ophthalmology (Drs Kymes and Varma), and H. Dunbar Hoskins Jr, MD, Center for Quality Eye Care (Dr Coleman), San Francisco, and Department of Ophthalmology, Doheny Eye Institute, Keck School of Medicine, University of Southern California (Dr Varma) and Department of Ophthalmology, Jules Stein Eye Institute and Department of Epidemiology, School of Public Health, University of California (Dr Coleman), Los Angeles.

Arch Ophthalmol. 2012;130(9):1232-1234. doi:10.1001/archophthalmol.2012.1217

We read with interest the article by Rein et al1 in which they used a decision analytic model and found that vision screening during the initial preventive physical examination does not meet accepted standards for cost-effectiveness; however, such modeling is very dependent on the underlying assumptions, many of which are contentious. For example, a key parameter in their simulation was the sensitivity of screening for detection of uncorrected refractive error (sensitivity, 0.70), which was drawn from a British study of 89 patients with hip fracture.2 A complete 1-way sensitivity analysis of this essential variable to determine at what value of sensitivity vision screening in the initial preventive physical examination would be preferred is needed, as is a discussion on whether that value is clinically viable. Without sensitivity analyses of key assumptions, an essential element of decision analytic modeling, readers do not have an understanding of the confidence they can have in the results. We encourage the authors to perform sensitivity analyses on all of their assumptions so the vision community might fully evaluate their recommendations.

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