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Editors Selection IGR 8-2
Health economics: Utilities
Comment by Melissa Brown & Gary Brown & John Peet on:
13938 Cost-effectiveness analysis in glaucoma: what drives utility? Results from a pilot study in Sweden, Kobelt G; Jonsson B; Bergstrom A et al., Acta Ophthalmologica Scandinavica, 2006; 84: 363-371
The article by Kobelt et al. (607) is an important contribution to the literature in the era of geometrically increasing interest in value-based medicine.1,2 Value-based medicine is the practice of medicine based upon the patient value (improvement in length-of-life and/or quality-of-life) conferred by interventions. In ophthalmology, value gain occurs primarily as improvement in quality-of-life. Utility analysis, as used by the authors, is a very effective instrument which measures the quality-of-life associated with a health state.1,2
The authors found that ocular utilities diminish as vision in the better-seeing eye decreases, a finding very similar to that noted by other researchers.2 This validation of dramatic utility diminution with decreasing vision, and dramatic utility increase
with improving vision is of immense importance to every practicing ophthalmologist, since it demonstrates the considerable value we deliver to patients (from their points of view). The improvement in quality-of-life conferred by most ophthalmic interventions can thus be readily quantified. And the superior patient value conferred by ophthalmic interventions should be most gratifying to practicing ophthalmologists.2
Of great interest is the fact that Kobelt and colleagues noted visual field loss did not correlate with utility change until the loss was far advanced. Thus, similar to the findings of our group at the Center for Value-Based Medicine and others,3 preservation of field in glaucoma patients has not be demonstrated to improve quality-of-life, at least not until glaucoma is far advanced.
Does this mean that treatment of glaucoma confers no or minimal value in most cases? While this may seem so at face value, nothing could be further from the truth. The diminution in quality-of-life which occurs in end-stage glaucoma is so severe that treatment confers considerable value. Even when costs and outcomes (value gain) are discounted over the years, the treatment remains highly valued because the end-result without treatment is so grim.
Ocular utilities diminish as vision in the better-seeing eye decreasesIt is gratifying to us to see excellent papers such as this using utility analysis to measure the value conferred by interventions. Unlike many other quality-of-life instruments, utility analysis: 1) encompasses all factors including within the quality-of-life sphere; 2) can compare quality-of-life across all health states; and 3) can be used in healthcare economic analyses.
We congratulate the authors on a fine treatise. Their study is well-designed, well executed, and has important findings. Judging from the very high quality of their endeavor, we expect many more important studies will follow.
Melissa M. Brown, MD, MN, MBA, Director, Center for Value-Based Medicine, Flourtown, PA, USA Gary C. Brown, Co-Director, Center for Value-Based Medicine, Flourtown, PA, USA John Peet, Staff, Center for Value-Based Medicine, Flourtown, PA, USA
References
- Brown MM, Brown GC, Sharma. Evidence-Based to Value-Based Medicine. Chicago, AMA Press, 2005.
- Brown MM, Brown GC, Sharma S, Landy J. Health care economic analyses and value-based medicine. Surv Ophthalmol 2003; 48: 204-223.
- Jampel J, Schwartz A, Pollack I, Abrams D, Weiss H, Miller R. Glaucoma patients’ assessment of their visual function and quality of life. J Glaucoma 2002; 11: 154-165.
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