Elsevier

Ophthalmology

Volume 109, Issue 12, December 2002, Pages 2265-2271
Ophthalmology

Regular article
A cost-utility analysis of therapy for amblyopia

Presented at the annual meeting of the American Academy of Ophthalmology, November 2001.
https://doi.org/10.1016/S0161-6420(02)01286-1Get rights and content

Abstract

Objective

Evaluation of the incremental cost-effectiveness of therapy for amblyopia.

Design

Cost-utility reference-case analysis.

Methods

A cost-utility analysis was performed from a third-party insurer perspective by using decision analysis, evidence-based data from the literature, and patient preference-based time trade-off utility values.

Database

Patient-derived time trade-off ocular utility values and the American Academy of Ophthalmology Preferred Practice Pattern guidelines for the treatment of amblyopia.

Intervention

Treatment of childhood amblyopia using medical and surgical therapies per the American Academy of Ophthalmology Preferred Practice Pattern.

Main outcome measure

Dollars (year 2001 nominal U.S. dollars) expended per quality-adjusted life-year ($/QALY) gained.

Results

Treatment for amblyopia resulted in a $/QALY gained of $2281 with a discount rate of 3% for costs and outcomes. Sensitivity analysis, varying costs and utility values by 10%, resulted in a $/QALY gained range from $2053 to $2509.

Conclusions

When compared with other interventions in health care, therapy for amblyopia seems to be highly cost-effective. This information is increasingly important for health care policy makers.

Section snippets

Overview

Software produced by Treeage, Inc. (Williamstown, MA)16 was used to perform decision analysis17, 18 to simulate clinical situations involving amblyopia therapy and no therapy for the eyes of patients with amblyopia. The microcomputer model took into account the mortality within the group of patients with amblyopia, as well as the treatment results, expressed in utility value form. Utility values were used at the terminal nodes at the right side of the decision tree to provide the reference case

Results

Decision analysis revealed that, over the 77-year life expectancy of the average patient, 0.80055 QALYs were gained from amblyopia therapy. The mean cost-effectiveness for each amblyopia treatment variant, discounted with series present value methodology, is shown in Table 3. With a 3% discount rate, it was $2281/QALY (year 2001 nominal U.S. dollars) in the costliest group, which consisted of all weighted treatments, and was $1726/QALY when all surgical interventions in the treatment of

Discussion

The data presented show that amblyopia therapy yields a $/QALY gained of $2281 with a 3% discount rate and year 2001 U.S. nominal dollars. This analysis takes into account the medical incremental costs associated with surgical and nonsurgical treatment of amblyopia. It does not incorporate the medical costs of screening for amblyopia or the associated societal costs, such as the iatrogenic psychosocial effect of occlusion therapy,49 school absences, missed work for caregivers, and

References (64)

  • B.E.K. Klein et al.

    Performance-based and self-assessed measures of visual function as related to history of falls, hip fractures, and measured gait time. The Beaver Dam Study

    Ophthalmology

    (1998)
  • D.A. Redelmeier et al.

    A clinician’s guide to utility measurement

    Prim Care

    (1995)
  • G.C. Brown et al.

    Difference between ophthalmologists’ and patients’ perceptions of quality of life associated with age-related macular-degeneration

    Can J Ophthalmol

    (2000)
  • G.C. Brown et al.

    Evidence-based medicine and cost-effectiveness

    J Health Care Finance

    (1999)
  • B.F. Gage et al.

    Cost-effectiveness of warfarin and aspirin for prophylaxis of stroke in patients with nonvalvular atrial fibrillation

    JAMA

    (1995)
  • M.M. Brown et al.

    Evidence-based medicine, utilities, and quality of life

    Curr Opin Ophthalmol

    (1999)
  • B.J. O’Brien et al.

    User’s guide to medical literature. XIII. How to use an article on economic analysis of clinical practice. B. What are the results and will they help me in caring for my patients? Evidence-Based Medicine Working Group

    JAMA

    (1997)
  • G.C. Brown

    Vision and quality-of-life

    Trans Am Ophthalmol Soc

    (1999)
  • G.C. Brown et al.

    Cost-effectiveness of therapy for threshold retinopathy of prematurity

    Pediatrics

    (1999)
  • G.C. Brown et al.

    Incremental cost-effectiveness of laser therapy for choroidal neovascularization associated with histoplasmosis

    Retina

    (2000)
  • M.M. Brown et al.

    Cost-effective analysis. The value component of evidence-based medicine

    Evidence-Based Eye Care

    (2000)
  • T. Vinding et al.

    Prevalence of amblyopia in old people without previous screening and treatment. An evaluation of the present prophylactic procedures among children in Denmark

    Acta Ophthalmol (Copenh)

    (1991)
  • C. Hoyt

    Amblyopia [editorial]

    Br J Ophthalmol

    (2000)
  • D.E. Krueger et al.

    Report on the National Eye Institute’s Visual Acuity Impairment Survey Pilot Study

    (1984)
  • A. Hillis

    Amblyopiaprevalent, curable, neglected

    Public Health Rev

    (1986)
  • R.N. Anderson

    United States Life Tables, 1997. National Vital Statistics Reports

  • Data™ 3.5 Healthcare User’s Manual

    (1999)
  • A.S. Detsky et al.

    Primer on medical decision analysispart 2–building a tree

    Med Decis Making

    (1991)
  • D. Naimark et al.

    Primer on medical decision analysispart 5–working with Markov processes

    Med Decis Making

    (1997)
  • J.E. Siegel et al.

    Recommendations for reporting cost-effectiveness analyses. The Panel on Cost-Effectiveness in Health and Medicine

    JAMA

    (1996)
  • J.T. Flynn et al.

    The therapy of amblyopiaan analysis comparing the results of amblyopia therapy utilizing two pooled data sets

    Trans Am Ophthalmol Soc

    (1999)
  • Amblyopia. Preferred Practice Pattern

    (1997)
  • Cited by (121)

    • Treatment compliance in amblyopia: A mini-review and description of a novel online platform for compliance tracking

      2022, Survey of Ophthalmology
      Citation Excerpt :

      Untreated amblyopia can have a significant effect on patients’ self-perception, quality of life, functional skills, employment prospects, and overall risk of blindness (from the potential loss of vision in the fellow eye).1,9,12,65,82,112 Additionally, amblyopia is estimated to cost the US more than 7 billion dollars per year in unmet earnings potential.58 A variety of modalities have been proven effective in the treatment of amblyopia.

    • Pickwell’s Binocular Vision Anomalies

      2021, Pickwell's Binocular Vision Anomalies
    • Guide de pratique clinique fondé sur des données probantes pour l'examen périodique de la vue chez les enfants de 0 à 5 ans au Canada

      2019, Canadian Journal of Ophthalmology
      Citation Excerpt :

      Dans l'ensemble, les bienfaits du dépistage et du traitement, lorsqu'un trouble est décelé, prévalent sur les préjudices et les coûts occasionnés.20,51–53 En effet, il appert que le traitement de l'amblyopie est l'une des interventions médicales les plus rentables au monde.54,55 L'amblyopie non ou insuffisamment traitée peut mener à une déficience visuelle et à une réduction de la qualité de vie permanentes.

    View all citing articles on Scopus

    Manuscript no. 210586.

    Supported in part by the Premier’s Award for Excellence, Ontario, Canada, and Principal’s Initiative Research Fund, Kingston, Ontario, Canada.

    View full text