Value based medicine

In a fine recent editorial, Drs Melissa and Gary Brown raised issues at the nexus of health policy and clinical science.1 As utility assessment is relatively new to the visual sciences, understanding both the assumptions behind this work and the consequences of relaxing those assumptions is essential for the conduct of high quality research and appropriate interpretation of the results.

The use of community elicited utilities (that is, including people without the disease in the elicitation study) in economic evaluation should be given more than minimal consideration. Economic evaluations are intended to inform health policy makers by assessing the value society places on the cure or prevention of disease. Community based utilities typically reflect larger estimates of utility loss than those elicited from patients and result in a more favourable analysis of the cost effectiveness of preventive interventions than those relying on patient elicited utilities.2 At the same time, estimating community elicited utilities requires the development of easily understood scenarios to assist community members in understanding life with the disease,3 after leading investigators prefer to rely on patient elicited utilities. Rather than dismiss the community elicited approach, economic evaluation in ophthalmology would be greatly facilitated by development of a catalogue of community …