Quality of life associated with visual loss: A time tradeoff utility analysis comparison with medical health states

doi:10.1016/S0161-6420(03)00254-9

Ophthalmology

Volume 110, Issue 6, June 2003, Pages 1076-1081

https://doi.org/10.1016/S0161-6420(03)00254-9 Get rights and content

Abstract

Purpose

To assess the visual utility values of patients with ocular disease and to compare these values with those of patients with systemic health states

Design

Cross-sectional utility value assessment.

Methods

Consecutive patients with ophthalmic diseases were interviewed in a one-on-one fashion using a standardized time tradeoff utility value assessment form. These values were compared with utility values for systemic health states present in the literature.

Intervention

None.

Main outcome measure

Time tradeoff utility value on a scale ranging from 1.0 (perfect visual health) to 0.0 (death). The ophthalmic patient groups were stratified into 4 visual groups dependent on the visual acuity in the better-seeing eye. The groups were as follows: group 1, 20/20 to 20/25; group 2, 20/30 to 20/50; group 3, 20/60 to 20/100; group 4, 20/200 to no light perception.

Results

A total of 500 subjects were enrolled in the study. The mean utility values for the visually stratified groups were: group 1, 0.88; group 2, 0.81; group 3, 0.72; group 4, 0.61. Comparable respective systemic health state utility values for each of the ophthalmic groups were: diabetes mellitus, status after kidney transplantation, moderate stroke, and moderately severe stroke.

Conclusions

Visual loss is associated with a substantial and measurable diminution in quality of life. This diminution in quality of life can be directly compared with that induced by systemic health states.

Section snippets

Study sample

Consecutive patients with ophthalmic diseases from 2 ophthalmologic practices, one predominantly vitreoretinal (GCB) and the second a comprehensive ophthalmic practice (MMB), were recruited for the study. The study purpose was explained to patients, and those who agreed to participate were interviewed by one of the authors using a standardized questionnaire. The main inclusion criterion was the presence of ocular disease. The major exclusion criteria were the presence Alzheimer’s disease or

Results

A total of 515 subjects were interviewed to obtain 500 visual utility values. Fifteen (3%) subjects of the sample were unable to answer the utility value questions effectively. Ten additional subjects who were asked to participate in the study declined to do so.

Among the 500 subjects for whom the data were analyzed, there were 197 males and 303 females. The mean age was 67.5 years (SD, 12.2; 95% CI, 66.5–68.5), with a range from 23 years to 90 years and a median age of 70 years. There were 470

Discussion

From the data presented herein, it is apparent that ocular diseases can diminish substantially the quality of life of an affected patient. This degree of diminution of quality of life can then be compared with that induced by other health states. Negligible visual loss in the presence of ocular disease seems to reduce the quality of life to the same degree as having diabetes mellitus or a mild stroke. Although people with negligible visual loss likely can function well in the activities of

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Measuring Quality of Life in Diabetic Retinal Disease: A Narrative Review of Available Patient-Reported Outcome Measures
2024, Ophthalmology Science
Several patient-reported outcome measures (PROMs) are available to measure health-related quality of life (HRQoL) in patients with late-stage clinical diabetic retinal diseases (DRDs). However, an understanding of the psychometric properties of PROMs is needed to assess how they could relate to severity levels of a revised DRD grading system. This narrative review assessed the available generic-, vision-, and DRD-related PROMs used in DRD research and highlights areas for improvement.
Diabetic retinal disease is a common complication of diabetes and can lead to sight-threatening complications with a devastating effect on HRQoL.
The Quality of Life working group is one of 6 working groups organized for the DRD Staging System Update Effort, a project of the Juvenile Diabetes Research Foundation Mary Tyler Moore Vision Initiative. PubMed, Cochrane Library, Embase, and Google Scholar databases were searched using core keywords to retrieve ophthalmology-related review articles, randomized clinical trials, and prospective, observational, and cross-sectional studies in the English language. A detailed review of 12 PROMs (4 QoL questionnaires and 8 utilities) that met a minimum level of evidence (LOE) was conducted. The relevance of each PROM to DRD disease stage and Biomarker Qualification guidelines (Biomarkers, EndpointS, and other Tools) categories was also defined.
The National Eye Institute 25-item Visual Function Questionnaire (NEI VFQ-25), Impact of vision impairment-computerized adaptive testing, and Diabetic Retinopathy and Macular Edema Computerized Adaptive Testing System had a LOE of II in detecting change due to late-stage DRD (diabetic macular edema), although several areas for improvement (e.g., psychometrics and generalizability) were identified. Other PROMs, particularly the utilities, had a LOE of III due to cross-sectional evidence in late-stage clinical DRD. Although the NEI VFQ-25 has been the most widely used PROM in late-stage DRD, more work is required to improve its multidimensional structure and other psychometric limitations. No PROM was deemed relevant for subclinical or early/mid-DRD.
This narrative review found that the most commonly used PROM is NEI VFQ-25, but none meets the ideal psychometric, responsiveness, and clinical setting digital administration requirements that could be included in an updated DRD staging system for diagnosis and monitoring of DRD progression.
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Preference-based comparison of quality of life associated with vision loss in Black and White ophthalmic populations in the US
2024, Canadian Journal of Ophthalmology
Utilities are preference-based estimates, typically ranging from 1.00 (normal health) to 0.00 (death), that quantify the quality-of-life improvement associated with a health care intervention. In conjunction with length-of-life gain, depending on the intervention, they measure total interventional value gain in quality-adjusted life years that can be integrated with costs in cost-utility analysis. We believed it relevant to ascertain whether race was a differentiating factor confounding utilities related to vision.
An analysis of cross-sectional data obtained from consecutive Black and White ophthalmic outpatients from the Wills Eye Hospital (Philadelphia, PA.) practices who participated in a long-standing time trade-off (TTO) vision utility study from 1999 to 2016 was undertaken. Each participant was interviewed by a researcher using a previously validated and reliable TTO vision utility acquisition instrument and assigned to 1 of 5 vision categories according to acuity in the best-seeing eye. Utility outcomes were compared using both the 2-sided t test and the Mann–Whitney U test.
Eleven hundred and twenty-five consecutive patients able to successfully answer the questions were included. For vision of 20/200–20/800, White/Black mean vision utilities were, respectively, 0.58/0.59 (p = 0.84); for vision of 20/70–20/100, they were, respectively, 0.72/0.70 (p = 0.85); for vision of 20/50–20/60, they were, respectively, 0.78/0.79 (p = 0.86); for vision of 20/25–20/50, they were, respectively, 0.84/0.88 (p = 0.16); and for vision of 20/20, they were, respectively, 0.91/0.90 (p = 0.43).
TTO vision utilities in Black and White ophthalmic patient cohorts were alike at various levels of visual acuity. This suggests a similar quality of life and that TTO vision utilities used in cost-utility analysis do not require adjustment for race in Black and White ophthalmic populations in the US.
Le concept d'utilité consiste en une estimation des préférences individuelles, dont la fourchette s’étend normalement de 1,00 (meilleur état de santé possible) à 0,00 (décès). L'utilité permet de mesurer l'amélioration de la qualité de vie en lien avec une intervention de soins de santé. Conjointement à l'augmentation de l'espérance de vie, elle permet – selon le type d'intervention – d’évaluer le gain total de valeur lié à l'intervention en années de vie ajustées en fonction de la qualité, lequel peut être intégré aux coûts dans le cadre d'une analyse coût-utilité. À notre avis, il était pertinent de vérifier si la race représentait un facteur de confusion de l'utilité en ce qui a trait à la vision.
On a réalisé une analyse des données transversales des dossiers de patients noirs et caucasiens ambulatoires consécutifs qui ont consulté les cabinets d'ophtalmologie du Wills Eye Hospital (Philadelphie, Pennsylvanie), cabinets prenant part à une étude de longue durée (1999 à 2016) évaluant l'utilité relative à la vision au moyen de la technique de l'arbitrage temporel (ou TTO, time trade-off). Chaque participant a été interviewé par un chercheur grâce à un outil d'arbitrage temporel validé et fiable de mesure de l'utilité relative à la vision, puis une cote de 1 à 5 était attribuée à la vision en fonction de l'acuité visuelle du meilleur œil. Les résultats de l'analyse d'utilité ont été comparés à l'aide d'un test t bilatéral et du test U de Mann-Whitney.
Ainsi, 1125 patients consécutifs qui étaient en mesure de répondre aux questions ont été inclus à notre étude. En présence d'une vision 20/200–20/800, les résultats moyens de l'analyse d'utilité relative à la vision des patients caucasiens/noirs s’élevaient respectivement à 0,58/0,59 (p = 0,84); en présence d'une vision 20/70–20/100, les résultats s’élevaient respectivement à 0,72/0,70 (p = 0,85); en présence d'une vision 20/50–20/60, les résultats s’élevaient respectivement à 0,78/0,79 (p = 0,86); en présence d'une vision 20/25–20/50, les résultats s’élevaient respectivement à 0,84/0,88 (p = 0,16) et, enfin, en présence d'une vision 20/20, les résultats s’élevaient respectivement à 0,91/0,90 (p = 0,43).
L'analyse de l'utilité relative à la vision par arbitrage temporel chez des patients noirs et caucasiens qui consultent un cabinet d'ophtalmologie a donné des résultats semblables, et ce, aux différents degrés d'acuité visuelle. On peut donc conclure à une qualité de vie similaire, de sorte que les valeurs d'utilité relatives à la vision acquises par arbitrage temporel qui sont utilisées dans les analyses coût-utilité n'ont pas besoin d’être ajustées en fonction de la race (noire ou caucasienne) des patients qui reçoivent des soins ophtalmologiques aux États-Unis.
Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study
2022, Journal of Pediatrics
To test the association of material deprivation and the utilization of vision care services for young children.
We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician.
Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas.
Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.
Vision-related quality-of-life estimates in adolescent youths
2021, Canadian Journal of Ophthalmology
Citation Excerpt :
We assumed this was equivalent to 20/200 or worse vision. The youth utilities were compared with previously reported cohorts.1–4,15 The first consisted of adults in the general population15 and the second consisted of ophthalmic patients with vision decreased to the same levels the youths were asked to estimate.1–4
To estimate perceptions of quality-of-life (QOL) associated with vision loss in youths under age 21 and compare them with adult general community perceptions and those of ophthalmic patients with vision loss.
Cross-sectional, time tradeoff (TTO), utility analysis.
Consecutive youths aged 13–20 years who agreed to participate in the study.
Vision utilities were acquired from adolescents asked to estimate the QOL associated with 3 vision scenarios using a validated, reliable, interviewer-administered TTO utility instrument. The scenarios modeled included: (i) mild vision loss (20/40–20/60), (ii) moderate vision loss (20/70–20/100), and (iii) severe vision loss (≤20/200). Results were compared with utilities previously gathered from the adult general community and from vision-impaired patients with acuity loss to the level of the modeled scenarios.
Mean TTO vision utilities were: scenario 1: youths (0.96) versus patients (0.79) (p < 0.0001); scenario 2: youths (0.88) versus patients (0.72) (p < 0.0001); scenario 3: (analysis of variance p < 0.0001) Tukey's Honestly Significant Difference Test, youths (0.79) versus patients (0.60) (p < 0.01), youths (0.79) versus adult general community (0.85) (p < 0.01), adult general community (0.85) versus patients (0.60) (p < 0.01).
Adolescents underestimated the effects of mild, moderate, and severe vision loss upon QOL referent to patients with actual vision loss (p < 0.0001), and thus are not good patient surrogates for utilities used in cost-utility analysis. Nonetheless, youth estimates were closer to those of patients with vision loss than were adult general community estimates. These findings emphasize the importance of using patient utilities in cost-utility analysis.
Évaluer les perceptions quant à la qualité de vie (QdV) associée à la perte de vision chez des jeunes de moins de 21 ans et les comparer à celles d'adultes issus de la collectivité globale et à celles de patients qui présentent effectivement une perte de vision.
Analyse d'utilité transversale avec arbitrage temporel (TTO, pour time tradeoff).
Jeunes consécutifs âgés entre 13 et 20 ans qui ont accepté de prendre part à l’étude.
Des énoncés sur la vision ont été obtenus auprès d'adolescents auxquels on a demandé d’évaluer la QdV associée à 3 scénarios de vision à l'aide d'un instrument validé et fiable utilisant la méthode de l'arbitrage temporel et administré par l'intervieweur. Les 3 scénarios étaient les suivants: (i) légère perte de vision (20/40–20/60), (ii) perte de vision modérée (20/70–20/100) et (iii) perte de vision importante (≤ 20/200). Les résultats ont été comparés à des évaluations préalablement recueillies auprès d'adultes issus de la collectivité globale et auprès de patients dont la perte de vision correspondait à chacun des 3 scénarios.
Les résultats TTO moyens sur la vision se déclinent comme suit : scénario 1 – jeunes (0,96) vs patients (0,79), p < 0,0001; scénario 2 – jeunes (0,88) vs patients (0,72), p < 0,0001; scénario 3 – analyse de variance, p < 0,0001; test de Tukey sur les différences significatives : jeunes (0,79) vs patients (0,60), p < 0,01; jeunes (0,79) vs adultes issus de la collectivité globale (0,85), p < 0,01; adultes issus de la collectivité globale (0,85) vs patients (0,60), p < 0,01.
Les adolescents sous-estimaient les effets d'une perte de vision légère, modérée et importante sur la QdV, comparativement aux patients qui présentaient effectivement une perte de vision (p < 0,0001). Ces sujets ne sont donc pas de bons substituts pour les patients quant aux énoncés utilisés dans le cadre d'une analyse coût-utilité. Malgré tout, les évaluations des jeunes se rapprochaient plus de celles des patients qui présentaient une perte de vision que celles d'adultes issus de la collectivité globale. Voilà qui souligne l'importance de recourir à des énoncés de patients lors de la réalisation d'analyses coût-utilité.
Vision-Related Quality Of Life And Depression In Brazilian Patients With Toxoplasmic Retinochoroiditis: Ocular Toxoplasmosis, Quality Of Life And Depression
2021, International Journal of Infectious Diseases
To investigate visual-related quality of life (VRQL) and prevalence and severity of depressive symptoms in Brazilian individuals with toxoplasmic retinochoroiditis (TRC).
Comparative observational cross-sectional study. The National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Beck Depression Inventory-II (BDI-II) were applied to respectively assess VRQL and depression in individuals consecutively seen at a uveitis referral center. Clinical/demographical data were collected. Descriptive/analytic statistics were employed, with P<0.05.
Patients and controls were comparable concerning age, sex and socioeconomic level. VRQL scores for all subscales were significantly lower in TRC when compared with controls, particularly associated (P<0.05) with female sex, history of ≥2 prior TRC recurrences, concomitant use of systemic corticosteroids, monocular vision and blindness. Depressive symptoms were more prevalent in TRC (55/188; 29.2%) than in controls (34/182; 18.7%) (P=0.023), also being associated with lower VRQL scores (P<0.001). Seropositive and seronegative controls for toxoplasmosis had similar VRQL scores and comparable rates of depressive symptoms.
TRC affects VRQL in Brazilian individuals, particularly women, using systemic corticosteroids, with visual impairment and presenting recurrences of TRC. One-third of patients with TRC had evidence of depression, which was also associated with lower VRQL scores. Mental health issues in subjects with TRC should not be overlooked.
Cost-Utility Analysis of VEGF Inhibitors for Treating Neovascular Age-Related Macular Degeneration
2020, American Journal of Ophthalmology
Citation Excerpt :
The respective ophthalmic CURs of bevacizumab, ranibizumab, and aflibercept of $11,033/QALY, $79,600/QALY and $44,801/QALY considerably exceed the $1,007/QALY CUR for first-eye cataract surgery,68 although all interventions are cost-effective. Mean QOL gain from NVAMD therapy herein was 26.5%, versus 34.2% for first-eye cataract surgery,63 all excellent compared to interventions across medicine.57 Our most pronounced limitation is the lack of 11-year randomized trial data.
To perform 11- and 2-year health care sector (ophthalmic) and societal cost perspective reference case, cost-utility analyses comparing bevacizumab, ranibizumab, and aflibercept monotherapies for neovascular age-related macular degeneration (NVAMD).
Cost-utility analysis.
The authors performed 11-year and 2-year ophthalmic and societal cost perspective, cost-utility analyses comparing bevacizumab, ranibizumab, and aflibercept monotherapies for neovascular age-related macular degeneration (NVAMD). We employed patient utilities, bilateral outcomes, 2018 U.S. dollars, vision-related mortality, a Medicare fee schedule, and CATT (Comparison of Age-Related Macular Degeneration Treatments) study and VIEW (VEGF Trap-Eye: Investigation of Efficacy and Safety in Wet AMD) trial. Cochrane data were also used. Setting: Center for Value-Based Medicine. Patient/study population: patients with NVAMD. Intervention: Cost-utility analyses using published data. Data-modeled 10-year vision outcomes were modeled forward to year 11. Main outcome measurement: These included cost-utility ratios (CURs), costs, and quality-adjusted life-years (QALYs) gained. $100,00/QALY was considered the US cost-effectiveness upper limit.
Bevacizumab and ranibizumab each conferred an 11-year, 1.339 QALY gain versus observation. Aflibercept conferred a 1.380 QALY gain. Aflibercept conferred greater QALY gain for less cost than ranibizumab but was not cost-effective compared to bevacizumab ($1,151,451/QALY incremental CUR). The average ophthalmic cost perspective CUR for bevacizumab was $11,033/QALY, $79,600/QALY for ranibizumab, and $44,801/QALY for aflibercept. Eleven-year therapies saved a 1.0 year-of-life loss without treatment from the 11.0-year life expectancy. Early treatment was 138%-149% more cost-effective than late treatment. Two-year therapy prevented a 1-month-of-life loss, and revealed bevacizumab, ranibizumab, and aflibercept conferred 0.141, 0.141, and 0.164 QALY gains, respectively, with corresponding average CURs of $40,371/QALY, $335,726/QALY, and $168,006/QALY, respectively.
From an ophthalmic (medical) cost perspective, bevacizumab, ranibizumab, and aflibercept NVAMD monotherapies were all cost-effective over 11 years, with bevacizumab 6.21× more cost-effective than ranibizumab and 3.06× more cost-effective than aflibercept. Two-year modeling revealed bevacizumab was cost-effective, whereas ranibizumab and aflibercept were not. Early treatment was critical for obtaining optimal vision and cost-effectiveness, as is long-term follow-up and adherence to treatment.

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^☆

Manuscript no. 210517.

Supported in part by the Retina Research and Development Fund, Philadelphia, Pennsylvania; The Premier’s Award for Excellence, Ontario, Canada; and Principal’s Initiative Research Fund, Kingston, Ontario, Canada.

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Quality of life associated with visual loss: A time tradeoff utility analysis comparison with medical health states☆

Abstract

Purpose

Design

Methods

Intervention

Main outcome measure

Results

Conclusions

Section snippets

Study sample

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

Can J Ophthalmol

J Diabetes Complications

Neuropharmacology

Gynecol Oncol

Kidney Int

J Chronic Dis

Gastroenterology

Am J Ophthalmol

Can J Ophthalmol

Evidence-Based Medicine. How to Practice and Teach EBM, 2nd ed

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Arch Ophthalmol

Early Treatment Diabetic Retinopathy Study Report Number 1. Early Treatment Diabetic Retinopathy Study Research Group

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Outcome of corneal transplantation

Br J Ophthalmol

Value-based medicine

Evidence-Based Eye Care

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Br J Ophthalmol

Health care in the 21st century. Evidence-based medicine, patient preference-based quality and cost-effectiveness

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Cost-effectiveness of therapy for threshold retinopathy of prematurity

Pediatrics

The cost-effectiveness of grid laser photocoagulation for the treatment of diabetic macular edemaresults of a patient-based cost-utility analysis

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Vision and quality of life

Trans Am Ophthalmol Soc

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Arch Ophthalmol

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Br J Ophthalmol