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

Stroupe, Kevin T.; Stelmack, Joan A.; Tang, Xiaoyin; Wei, Yongliang; Sayers, Scott; Reda, Domenic J.; Kwon, Ellen; Massof, Robert W.

doi:10.1001/jamaophthalmol.2018.0797

Cited by 13 publications

(13 citation statements)

References 24 publications

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“…Depending on agreements between organizations or policies in different countries, low vision rehabilitation services may be provided by commercial, non-profit, or charity organizations. [ 68 ]…”

Section: Discussionmentioning

confidence: 99%

Low vision rehabilitation in improving the quality of life for patients with impaired vision: Retraction

et al. 2021

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Background & aim: Low vision rehabilitation optimizes the use of residual vision after severe vision loss, but also teaches skills to improve visual functioning in daily life. These skills promote independence and active participation in society. This meta-analysis was designed to evaluate the efficacy of low vision rehabilitation in improving the quality of life (QoL) in visually impaired adults. Methods: We searched the Cochrane Library, PubMed, EMBASE, and Web of Science up to January 1, 2020. Randomized controlled trials (RCTs) that compared rehabilitation interventions with active or inactive controls were included. The standardized mean difference (SMD) with a 95% confidence interval (CI) was estimated to compare outcomes. Two reviewers extracted data and assessed trial quality independently. All statistical analyses were performed using the standard statistical procedures of RevMan 5.2. Results: A total of 52 RCTs with 6,239 participants were included in this meta-analysis. Compared to inactive comparators including waiting list or no care, low vision rehabilitation improved vision-related QoL, visual functioning (QoL: psychological aspect), and self-efficacy or self-esteem (QoL: psychological aspect), with pooled SMDs of −0.61 (95% CI −0.95 to −0.26; P = .0006), -1.14 (95% CI −1.69 to −0.59; P < .0001), and −0.84 (95% CI −1.47 to −0.22; P < .0001), respectively. Compared to active comparators, low vision rehabilitation improved vision-related QoL (SMD −0.26; 95% CI −0.46 to −0.06; P = .01) and activities of daily living (QoL: physical aspect) (SMD −0.39; 95% CI −0.67 to −0.12 P < .0001). However, no significant difference in health-related QoL and adaptation to vision loss (QoL: psychological aspect) was found between low vision rehabilitation and inactive comparators. Conclusions: This meta-analysis indicated that low vision rehabilitation interventions, particularly psychological therapies and methods of enhancing vision, may improve vision-related QoL and visual functioning in people with sight loss compared to usual care. Further studies should explore longer maintenance effects and the costs of several types of low vision rehabilitation. Studies characterizing the mechanisms of rehabilitation interventions in different settings, including low-income countries, are also required.

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Section: Discussionmentioning

confidence: 99%

Low vision rehabilitation in improving the quality of life for patients with impaired vision: Retraction

et al. 2021

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“…Previous research has shown that vision impairment in Portugal is a common condition that leads to significant costs at personal and societal levels . The general lack of cost‐effectiveness analysis (CEA) may delay decisions to implement more and better basic‐VRS and creates barriers to the development of vision rehabilitation . But, why do we need to perform a CEA now if magnifiers have been dispensed in many hospitals regularly since, at least, 1970? Recent systematic reviews showed that better evidence on the cost‐effectiveness of using magnifiers is necessary .…”

Section: Discussionmentioning

confidence: 99%

“…However, there is still a lack of knowledge regarding what impact VR can have on those economic issues. 14,19,[29][30][31] Cost-effectiveness analysis (CEA) and health economic analysis will reveal the impact of VR.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of basic vision rehabilitation (The basic VRS‐effect study): study protocol for a randomised controlled trial

Hernández-Moreno

Senra

Lewis

et al. 2020

Ophthalmic Physiologic Optic

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Purpose: To investigate the cost-effectiveness of a basic vision rehabilitation service (basic-VRS) in Portugal. We designed a parallel group, randomised controlled trial whose aim is to compare the effects and costs of 'usual low vision care' with a 'basic-VRS intervention' on self-reported visual ability and other psychosocial and health-related quality-of-life outcomes. Methods: The trial will recruit participants that meet the following inclusion criteria: (1) visual acuity between 0.4-1.0 logMAR in the better-seeing eye, (2) cause of vision loss is diabetic retinopathy or age-related macular degeneration, (3) 18 years or older and iv) live in the community (not in nursing homes or other type of institution). Participants will be randomised to one of the study arms consisting of immediate intervention and delayed intervention. The delayed intervention group will receive 'usual care' or no intervention in the first 12 weeks. Visual acuity, contrast sensitivity and retinal structure will be assessed during the study. Results: The primary outcome measure is visual ability, which will be evaluated with the Massof Activity Inventory, we expect that the intervention will raise the overall person measure or visual ability. Reading, health-related quality-of-life, anxiety and depression and social support will be also assessed. The analysis will be undertaken on an intention-to-treat basis. A cost-effectiveness analysis will be performed to provide information about the cost per unit of utility. To evaluate the cost-effectiveness of the intervention we will adopt the perspective of the healthcare system. Conclusion: This study will provide additional evidence about the effects of basic-VRS on self-reported visual ability. Findings from this study should also contribute to better planning of low vision provision and, consequently, may contribute to reduce barriers to basic-VRS.

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“…In general, there is still lack of studies examining the actual benefits of VR for people with VI. This lack of evidence entails barriers to the development of vision rehabilitation systems (VRS) [31][32][33][34]. Magnifiers, for example, have been dispensed in many hospitals regularly since, at least, 1970 [35].…”

Section: Introductionmentioning

confidence: 99%

Results of the basic-VRS trial: clinical outcomes and cost-effectiveness of basic low vision rehabilitation in Portugal

Hernández-Moreno

Senra

Marques

et al. 2022

Preprint

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Purpose The aim of this study was twofold: i) to investigate and characterize the clinical impact of vision rehabilitation in patients with vision impairment, and ii) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal. Methods Patients diagnosed with age-related macular degeneration or diabetic retinopathy and visual acuity in the range 0.4 to 1.0 logMAR in the better-seeing eye were recruited. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality-of-life and costs of the intervention were measured. Economic analysis was performed to evaluated if the intervention was cost-effective. The trial compared the outcomes 12-weeks after the start in both arms. Results Of the 46 participants, 34(74%) were diagnosed with diabetic retinopathy, 25(54%) were female and the mean age was 70.08 yrs (SD=8.74). In the immediate intervention arm visual ability was 0.28 logits (SD=1.14) at baseline and it increased to 0.91logits (SD=1.24) after the intervention (p<0.001). Changes in the delayed intervention arm were not statistically significant (mean improvement = 0.10 logits, SE=0.11, p=0.95). Acuity in the better seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was 118.79EURO (SD=24.37). Incremental cost-effectiveness ratio using the EQ-5D-5L index value was 3322EURO/QALY and 1235EURO/QALY when using near acuity. Conclusions The current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services.

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

Cited by 13 publications

References 24 publications

Low vision rehabilitation in improving the quality of life for patients with impaired vision: Retraction

Low vision rehabilitation in improving the quality of life for patients with impaired vision: Retraction

Cost‐effectiveness of basic vision rehabilitation (The basic VRS‐effect study): study protocol for a randomised controlled trial

Results of the basic-VRS trial: clinical outcomes and cost-effectiveness of basic low vision rehabilitation in Portugal

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