Opportunities to Reduce Potential Bias in Ophthalmic Cost-Utility Analysis

Area of Science:

• Ophthalmology
• Health Economics
• Health Services Research

Background:

• Cost-utility analysis is crucial for evaluating ophthalmic interventions.
• Existing methods may underestimate the value of treatments for certain populations.
• Patient-specific utilities are essential for accurate cost-effectiveness assessments.

Purpose of the Study:

• To determine if using non-patient vision utilities or a maximum limit model biases cost-utility outcomes for ophthalmic interventions.
• To assess the impact of these methods on quality-adjusted life-year (QALY) gains and cost-effectiveness.

Main Methods:

• Economic evaluation using the Center for Value-Based Medicine database.
• Comparative effectiveness and cost-utility analyses for cataract surgery and NVAMD therapy.
• Utilized ophthalmic patient utilities versus non-ophthalmic patient utilities, with and without systemic comorbidity utility limits.

Main Results:

• Using non-ophthalmic utilities or utility limits significantly decreased QALY gains and cost-effectiveness for both cataract surgery and NVAMD therapy.
• Cataract surgery cost-effectiveness decreased by up to 206.8% when using both non-ophthalmic utilities and utility limits.
• NVAMD therapy cost-effectiveness decreased by up to 37.9% under similar conditions.

Conclusions:

• Non-patient vision utilities and maximum limit models introduce significant bias against ophthalmic interventions.
• This bias can lead to underestimation of patient value and cost-effectiveness, potentially harming disabled, elderly, and African American populations.
• Ophthalmologists must address these methodological biases to ensure equitable access to beneficial treatments and prevent negative impacts on research and reimbursement.