Value of Treatment for Combat Ocular Trauma

Combat ocular trauma (COT) represents a significant risk to U.S. warfighters, and the cost of COT can be substantial. We quantified the economic value associated with vision improvements from COT treatment and the potential value of treatment innovation or other interventions that result in better final vision following COT. Finally, we modeled the value associated with improved combat eye protection (CEP) compliance.

We developed an economic model to simulate COT injuries, treatment, and lifetime economic and vision outcomes for U.S. warfighters aged 25. Vision- and injury-related model inputs were derived from an analysis of the Defense and Veterans Eye Injury Registry (DVEIVR). Economic inputs were derived from a subsample of veterans from 3 nationally representative datasets. We compared current treatment patterns for COT with a counterfactual scenario in which warfighters' vision does not improve following COT as well as a hypothetical "best-case" scenario where all warfighters who suffer COT attain 20/40 or better final visual acuity (VA). Two CEP scenarios were parameterized using peer-reviewed literature. The injury reduction scenario assumed CEP reduces COT probability, and the severity reduction scenario assumed CEP reduces COT probability and injury severity conditional on COT. Model outcomes included VA, VA valued in dollars, earnings, employment, absenteeism, disability payments, medical expenditures, and COT treatment costs. Total value is calculated as the sum of direct (vision) benefits and indirect (economic) benefits minus COT treatment costs.

In a cohort of 249,657 warfighters, 800 suffered COT. Among those with COT, only 10.6% of them had 20/40 or better initial VA and under current treatment patterns 38.4% of them have 20/40 or better final VA. For a single warfighter with COT, lifetime value from current treatment is $547,062. This translates to $0.4 billion in total lifetime benefit for a single deployed cohort and $22.0 billion for multiple deployed cohorts over a 20-year timeframe ("stacked cohort"). Lifetime benefits are 4 times higher under the hypothetical best-case scenario compared with current treatment patterns: $2.4 million for a single warfighter with COT or approximately $94 billion for the stacked cohort. Increasing CEP compliance from baseline (77%) to either 85% or 95% averts 30 to 85 injuries, and total value per injury averted is $1.86 million. The severity reduction scenario additionally reduces the share of warfighters with COT with worse than 20/40 final VA from 39.0% to 38.4% and increases value per injury averted to $2.47 million. Improved CEP compliance yields $55.4 to $144.2 million in lifetime value for a single deployed cohort and $3.0 to $7.6 billion for a stacked cohort.

This study's findings suggest that improved vision resulting from COT treatment provides substantial economic value to warfighters and society, and that improved CEP compliance serves as an important driver of value. The results from this study can be used to inform future military decisions about resource allocation and whether to deploy ophthalmologists in combat settings. Better recordkeeping and data collection for key variables such as CEP status at the time of COT will allow for more precise estimates.