The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus | Ophthalmology | JAMA Ophthalmology | JAMA Network
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 National Health and Nutrition Examination Survey data (2005-2008). Centers for Disease Control and Prevention and National Center for Health Statistics Web site. Accessed November 28, 2011
Patino CM, McKean-Cowdin R, Azen SP, Allison JC, Choudhury F, Varma R.Los Angeles Latino Eye Study Group.  Central and peripheral visual impairment and the risk of falls and falls with injury.  Ophthalmology. 2010;117(2):199.e1-206.e19120031225PubMedGoogle ScholarCrossref
Rees G, Tee HW, Marella M, Fenwick E, Dirani M, Lamoureux EL. Vision-specific distress and depressive symptoms in people with vision impairment.  Invest Ophthalmol Vis Sci. 2010;51(6):2891-289620164466PubMedGoogle ScholarCrossref
 Medicare preventive services. Quick reference information: the ABCs of providing the initial preventive physical examination. Components of the IPPE. Centers for Medicare & Medicaid Services Web site. Accessed September 29, 2010
Chou R, Dana T, Bougatsos C. Screening older adults for impaired visual acuity: a review of the evidence for the U.S. Preventive Services Task Force.  Ann Intern Med. 2009;151(1):44-58, W11-2019581646PubMedGoogle Scholar
Rein DB, Saaddine JB, Wittenborn JS,  et al.  Cost-effectiveness of vitamin therapy for age-related macular degeneration.  Ophthalmology. 2007;114(7):1319-132617320962PubMedGoogle ScholarCrossref
Rein DB, Wittenborn JS, Lee PP,  et al.  The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States.  Ophthalmology. 2009;116(5):823-83219285730PubMedGoogle ScholarCrossref
Rein DB, Wittenborn JS, Zhang X,  et al; Vision Cost-Effectiveness Study Group.  The cost-effectiveness of three screening alternatives for people with diabetes with no or early diabetic retinopathy.  Health Serv Res. 2011;46(5):1534-156121492158PubMedGoogle ScholarCrossref
Vijan S, Hofer TP, Hayward RA. Cost-utility analysis of screening intervals for diabetic retinopathy in patients with type 2 diabetes mellitus.  JAMA. 2000;283(7):889-89610685713PubMedGoogle ScholarCrossref
Whited JD, Datta SK, Aiello LM,  et al.  A modeled economic analysis of a digital tele-ophthalmology system as used by three federal health care agencies for detecting proliferative diabetic retinopathy.  Telemed J E Health. 2005;11(6):641-65116430383PubMedGoogle ScholarCrossref
Javitt JC. Cost savings associated with detection and treatment of diabetic eye disease.  Pharmacoeconomics. 1995;8:(suppl 1)  33-3910159001PubMedGoogle ScholarCrossref
Rein DB, Saaddine JB, Wittenborn JS,  et al.  Technical appendix: cost-effectiveness of vitamin therapy for age-related macular degeneration.  Ophthalmology. 2007;114(7):e13-e2017462738PubMedGoogle ScholarCrossref
Age-Related Eye Disease Study Research Group.  A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report No. 8.  Arch Ophthalmol. 2001;119(10):1417-143611594942PubMedGoogle ScholarCrossref
Verteporfin In Photodynamic Therapy Study Group.  Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization--verteporfin in photodynamic therapy report 2.  Am J Ophthalmol. 2001;131(5):541-56011336929PubMedGoogle ScholarCrossref
Macular Photocoagulation Study Group.  Argon laser photocoagulation for neovascular maculopathy: five-year results from randomized clinical trials.  Arch Ophthalmol. 1991;109(8):1109-11141714270PubMedGoogle ScholarCrossref
Klein BEK, Klein RK, Lee KE. Incidence of age-related cataract over a 10-year interval: the Beaver Dam Eye Study.  Ophthalmology. 2002;109(11):2052-205712414414PubMedGoogle ScholarCrossref
West SK, Muñoz B, Schein OD, Duncan DD, Rubin GS. Racial differences in lens opacities: the Salisbury Eye Evaluation (SEE) project.  Am J Epidemiol. 1998;148(11):1033-10399850124PubMedGoogle ScholarCrossref
Klein BEK, Klein R, Linton KLP. Prevalence of age-related lens opacities in a population: the Beaver Dam Eye Study.  Ophthalmology. 1992;99(4):546-5521584573PubMedGoogle Scholar
 National Health and Nutrition Examination Survey data (2005-2006). Centers for Disease Control and Prevention and National Center for Health Statistics Web site. Accessed October 20, 2008
Sloan FA, Brown DS, Carlisle ES, Picone GA, Lee PP. Monitoring visual status: why patients do or do not comply with practice guidelines.  Health Serv Res. 2004;39(5):1429-144815333116PubMedGoogle ScholarCrossref
Moss SE, Klein R, Kessler SD, Richie KA. Comparison between ophthalmoscopy and fundus photography in determining severity of diabetic retinopathy.  Ophthalmology. 1985;92(1):62-672579361PubMedGoogle Scholar
Tikellis G, Robman LD, Harper A, McNeil JJ, Taylor HR, McCarty CA. Methods for detecting age-related maculopathy: a comparison between photographic and clinical assessment.  Clin Experiment Ophthalmol. 2000;28(5):367-37211097285PubMedGoogle ScholarCrossref
Harper R, Reeves B. The sensitivity and specificity of direct ophthalmoscopic optic disc assessment in screening for glaucoma: a multivariate analysis.  Graefes Arch Clin Exp Ophthalmol. 2000;238(12):949-95511196356PubMedGoogle ScholarCrossref
Williams C, Lumb R, Harvey I, Sparrow JM. Screening for refractive errors with the Topcon PR2000 pediatric refractometer.  Invest Ophthalmol Vis Sci. 2000;41(5):1031-103710752938PubMedGoogle Scholar
Luo HD, Gazzard G, Liang Y, Shankar A, Tan DT, Saw SM. Defining myopia using refractive error and uncorrected logMAR visual acuity >0.3 from 1334 Singapore school children ages 7-9 years.  Br J Ophthalmol. 2006;90(3):362-36616488963PubMedGoogle ScholarCrossref
Tong L, Saw SM, Chan ES,  et al.  Screening for myopia and refractive errors using LogMAR visual acuity by optometrists and a simplified visual acuity chart by nurses.  Optom Vis Sci. 2004;81(9):684-69115365388PubMedGoogle ScholarCrossref
Takeda AL, Colquitt J, Clegg AJ, Jones J. Pegaptanib and ranibizumab for neovascular age-related macular degeneration: a systematic review.  Br J Ophthalmol. 2007;91(9):1177-118217475698PubMedGoogle ScholarCrossref
American Academy of Ophthalmology (AAO), Preferred Practice Patterns Committee, Glaucoma Panel.  Primary Open-Angle Glaucoma. San Francisco, CA: AAO; 2006
Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E.Early Manifest Glaucoma Trial Group.  Factors for glaucoma progression and the effect of treatment: the Early Manifest Glaucoma Trial.  Arch Ophthalmol. 2003;121(1):48-5612523884PubMedGoogle ScholarCrossref
Rein DB, Zhang P, Wirth KE,  et al.  The economic burden of major adult visual disorders in the United States.  Arch Ophthalmol. 2006;124(12):1754-176017159036PubMedGoogle ScholarCrossref
Rein DB, Wittenborn JS, Zhang X, Honeycutt AA, Lesesne SB, Saaddine J.Vision Health Cost-Effectiveness Study Group.  Forecasting age-related macular degeneration through the year 2050: the potential impact of new treatments.  Arch Ophthalmol. 2009;127(4):533-54019365036PubMedGoogle ScholarCrossref
American Academy of Ophthalmology (AAO), Preferred Practice Patterns Committee.  Cataract in the Adult Eye. San Francisco, CA: AAO; 2008
Cooney J, Bae J, Curry RH,  et al.  Comparative assessment of cost and care outcomes among Georgia's community-based and facility-based long-term care programs final report. Georgia Health Policy Web site. Published June 2004. Accessed September 11, 2008
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-effectiveness in Health and Medicine. Oxford, England: Oxford University Press; 1996
Brown MM, Brown GC, Sharma S, Kistler J, Brown H. Utility values associated with blindness in an adult population.  Br J Ophthalmol. 2001;85(3):327-33111222340PubMedGoogle ScholarCrossref
Squirrell DM, Kenny J, Mawer N,  et al.  Screening for visual impairment in elderly patients with hip fracture: validating a simple bedside test.  Eye (Lond). 2005;19(1):55-5915184957PubMedGoogle ScholarCrossref
Gray L, Parkinson J. The Essential RBRVS. Salt Lake City, UT: St Anthoney's Publishing; 2003
American Medical Association.  CPT 2003: Current Procedural Terminology (Standard Edition). Chicago, IL: American Medical Association; 2002
 Data retrieval: labor force statistics (CPS). Table 3. Median usual weekly earnings of full-time wage and salary workers by age, race, Hispanic or Latino ethnicity, and sex, quarterly averages, not seasonally adjusted. US Dept of Labor/Bureau of Labor Statistics Web site. Accessed October 29, 2010
 Household data annual averages: 3. Employment status of the civilian noninstitutional population by age, sex, and race. US Dept of Labor/Bureau of Labor Statistics Web site. Accessed October 29, 2010
Brown MM, Brown GC, Sharma S, Landy J. Health care economic analyses and value-based medicine.  Surv Ophthalmol. 2003;48(2):204-22312686305PubMedGoogle ScholarCrossref
 FTP directory listing. National Ambulatory Medical Care Survey. Centers for Disease Control and Prevention Web site. Accessed October 29, 2010
Doubilet P, Begg CB, Weinstein MC, Braun P, McNeil BJ. Probabilistic sensitivity analysis using Monte Carlo simulation: a practical approach.  Med Decis Making. 1985;5(2):157-1773831638PubMedGoogle ScholarCrossref
Briggs A, Claxton K, Sculpher M. Decision Modelling for Health Economic Evaluation. Oxford, England: Oxford University Press; 2007
Tambour M, Zethraeus N. Bootstrap confidence intervals for cost-effectiveness ratios: some simulation results.  Health Econ. 1998;7(2):143-1479565170PubMedGoogle ScholarCrossref
Willan AR, Lin DY. Incremental net benefit in randomized clinical trials.  Stat Med. 2001;20(11):1563-157411391688PubMedGoogle ScholarCrossref
Clinical Sciences
May 2012

The Cost-effectiveness of Welcome to Medicare Visual Acuity Screening and a Possible Alternative Welcome to Medicare Eye Evaluation Among Persons Without Diagnosed Diabetes Mellitus

Author Affiliations

Author Affiliations: Public Health Research, NORC at the University of Chicago (Dr Rein), and National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, Centers for Disease Control and Prevention (Drs X. Zhang, P. Zhang, and Saaddine), Atlanta, Georgia; RTI International, Research Triangle Park, North Carolina (Mr Wittenborn and Dr Hoerger); and School of Medicine and Public Health, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison (Drs B. E. K. Klein and R. Klein and Ms Lee).

Arch Ophthalmol. 2012;130(5):607-614. doi:10.1001/archopthalmol.2011.1921

Objective To estimate the cost-effectiveness of visual acuity screening performed in primary care settings and of dilated eye evaluations performed by an eye care professional among new Medicare enrollees with no diagnosed eye disorders. Medicare currently reimburses visual acuity screening for new enrollees during their initial preventive primary care health check, but dilated eye evaluations may be a more cost-effective policy.

Design Monte Carlo cost-effectiveness simulation model with a total of 50 000 simulated patients with demographic characteristics matched to persons 65 years of age in the US population.

Results Compared with no screening policy, dilated eye evaluations increased quality-adjusted life-years (QALYs) by 0.008 (95% credible interval [CrI], 0.005-0.011) and increased costs by $94 (95% CrI, −$35 to $222). A visual acuity screening increased QALYs in less than 95% of the simulations (0.001 [95% CrI, −0.002 to 0.004) and increased total costs by $32 (95% CrI, −$97 to $159) per person. The incremental cost-effectiveness ratio of a visual acuity screening and an eye examination compared with no screening were $29 000 and $12 000 per QALY gained, respectively. At a willingness-to-pay value of $15 000 or more per QALY gained, a dilated eye evaluation was the policy option most likely to be cost-effective.

Conclusions The currently recommended visual acuity screening showed limited efficacy and cost-effectiveness compared with no screening. In contrast, a new policy of reimbursement for Welcome to Medicare dilated eye evaluations was highly cost-effective.