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Published on: August 25, 2021
Value of Reduced Time to Repair for Combat Ocular Trauma
Karen Mulligan1, Amanda M Staudt2, Juan Carlos Martinez Camarillo3
1Sol Price School of Public Policy, University of Southern California, Los Angeles, California; Leonard D. Schaeffer Center for Health Policy & Economics, University of California, Los Angeles, Los Angeles, California.
Purpose:
To evaluate how faster time to repair (TTR) after combat ocular trauma (COT) affects vision and economic outcomes.
Design:
For this economic evaluation, we developed a model to quantify the impact of TTR on direct and indirect benefits for a hypothetical deployed service member over a lifetime horizon.
Participants:
The Defense and Veterans Eye Injury and Vision Registry (DVEIVR) includes United States service members who were deployed in Operations Iraqi and Enduring Freedom between 2003 and 2020 and sustained COT. Economic outcomes were based on veterans in nationally representative datasets.
Methods:
We estimated the predicted probability of 20/40 or better final visual acuity (VA) after COT, stratified by TTR and injury severity using DVEIVR. Economic model inputs were derived from 3 nationally representative surveys.
Main Outcome Measures:
Model outcomes included VA, VA valued in dollars, earnings, absenteeism, disability payments, and medical expenditures.
Results:
The TTR analysis included 167 deployed service members (89.8% male; mean age, 27.3 years [standard deviation, 6.9 years]). Reducing TTR from 8+ days to 4 to 7 days for low-, moderate-, and high-severity COT increases the probability of 20/40 or better final VA by 16.0, 20.5, and 11.6 percentage points, respectively. The largest benefit was for moderate-severity COT: decreasing TTR from 8+ days to 4 to 7 days (or from 1 to 3 days to within 24 hours) generates $0.6 ($0.3) million in lifetime benefit for a hypothetical deployed service member. Earning increased 8% to 13% when TTR is reduced from 8+ days to 4 to 7 days. Reducing TTR from 4 to 7 days to within 24 hours for primary comprehensive reconstruction more than doubled lifetime economic benefit compared with reducing TTR from 4 to 7 days to 1 to 3 days.
Conclusions:
This study's findings suggest that reducing TTR after COT improves vision outcomes, which provides substantial economic value to deployed service members and society. In the face of limited resources, prioritizing treatment for moderate-severity injuries has the highest potential for gains. Although military and civilian ophthalmic trauma patients inherently differ, these results should be relevant for noncombat situations because timely ophthalmic care generally is available and concomitant injuries interfering with treatment are less common.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
