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?
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.
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.
Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently.
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.
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).
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.
ClinicalTrials.gov Identifier: NCT00958360.
Stroupe KT, Stelmack JA, Tang XC, et al. Economic Evaluation of Low-Vision Rehabilitation for Veterans With Macular Diseases in the US Department of Veterans Affairs. JAMA Ophthalmol. Published online April 12, 2018. doi:10.1001/jamaophthalmol.2018.0797
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