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Original Investigation
April 12, 2018

Economic Evaluation of Low-Vision Rehabilitation for Veterans With Macular Diseases in the US Department of Veterans Affairs

Author Affiliations
  • 1Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
  • 2Department of Public Health Sciences, Loyola University–Chicago, Maywood, Illinois
  • 3Blind Rehabilitation Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
  • 4Illinois College of Optometry, Chicago
  • 5Department of Ophthalmology and Visual Science, University of Illinois at Chicago, School of Medicine, Chicago
  • 6Cooperative Studies Program Coordinating Center, Edward Hines Jr Veterans Affairs Hospital, Hines, Illinois
  • 7Washington DC Medical Center, Washington
  • 8Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Ophthalmol. Published online April 12, 2018. doi:10.1001/jamaophthalmol.2018.0797
Key Points

Question  What are the costs and consequences of low-vision rehabilitation (including therapy and homework to teaching low-vision device use, eccentric viewing, and environmental modification) compared with basic low-vision services (low-vision devices dispensed without therapy) for veterans with macular diseases and a visual acuity of 20/50 to 20/200?

Findings  In this randomized clinical trial, health care costs were similar between patients receiving low-vision rehabilitation and basic low-vision services. However, low-vision rehabilitation required more time and transportation but was more effective for some patients.

Meaning  These findings suggest that low-vision rehabilitation was more effective with similar health care costs; however, low-vision rehabilitation may involve a greater time commitment and cost to patients.

Abstract

Importance  Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently.

Objective  To examine the costs and consequences of LV rehabilitation or basic LV services.

Design, Setting, and Participants  The US Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) II was conducted from September 27, 2010, to July 31, 2014, at 9 VA facilities and included 323 veterans with macular diseases and a best-corrected distance visual acuity of 20/50 to 20/200. Veterans were randomized to receive basic LV services that provided LV devices without therapy, or LV rehabilitation that added a therapist to LV services who provided instruction and homework on using LV devices, eccentric viewing, and environmental modification. We compared costs and consequences between these groups.

Interventions  Low-vision devices without therapy and LV devices with therapy.

Main Outcomes and Measures  Costs of providing basic LV services or LV rehabilitation were assessed. We measured consequences as changes in functional visual ability from baseline to follow-up 4 months after randomization using the VA Low Vision Visual Functioning Questionnaire. Visual ability was measured in dimensionless log odds units (logits).

Results  Of 323 randomized patients, the mean (SD) age was 80 (10.5) years, 314 (97.2%) were men, and 292 (90.4%) were white. One hundred sixty (49.5%) received basic LV services and 163 (50.1%) received LV rehabilitation. The mean (SD) total direct health care costs per patient were similar between patients who were randomized to receive basic LV services ($1662 [$671]) or LV rehabilitation ($1788 [$864]) (basic LV services, $126 lower; 95% CI, $299 lower to $35 higher; P = .15). However, basic LV services required less time and had lower transportation costs. Patients receiving LV rehabilitation had greater improvements in overall visual ability, reading ability, visual information processing, and visual motor skill scores.

Abstract

Trial Registration  ClinicalTrials.gov Identifier: NCT00958360.

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