Economic Evaluation of Blind Rehabilitation for Veterans With Macular Diseases in the Department of Veterans Affairs

• Published in: Ophthalmic epidemiology 2008-03, Vol.15 (2), p.84-91
• Main Authors: Stroupe, Kevin T., Stelmack, Joan A., Tang, X. Charlene, Reda, Domenic J., Moran, D'Anna, Rinne, Stephen, Mancil, Rickilyn, Wei, Yongliang, Cummings, Roger, Mancil, Gary, Ellis, Nancy, Massof, Robert W.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Blindness; Blindness - economics; Blindness - etiology; Blindness - rehabilitation; Cost Analysis; Costs and Cost Analysis - economics; Female; Follow-Up Studies; Humans; Low Vision; Macular Degeneration - complications; Macular Degeneration - economics; Male; Outpatient; Program Evaluation - economics; Program Evaluation - methods; Rehabilitation; Rehabilitation Centers - economics; Retrospective Studies; United States; United States Department of Veterans Affairs - economics; Veterans; Visual Acuity
• ISSN: 0928-6586; 1744-5086
• DOI: 10.1080/09286580802027836

Purpose: The Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) developed an outpatient low-vision programme for patients with macular diseases providing low-vision rehabilitation comparable to VA inpatient blind rehabilitation centres (BRCs). This programme targets veterans who do not need or chose not to participate in a comprehensive inpatient blind rehabilitation programme. We examined costs and consequences using veterans in LOVIT and comparable veterans in an inpatient BRC. Methods: We compared costs and consequences between treatment patients who participated in LOVIT, a two-site randomized clinical trial, and a sample of comparable patients who received treatment at a VA inpatient BRC. We measured consequences as the change in functional visual ability from baseline to follow-up (LOVIT: 4 months after randomization; BRC: 3 months after discharge) using the VA Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). Results: There were 55 LOVIT and 121 BRC patients for our analyses. Average costs were $38,627.3 higher for BRC patients ($5,054.4 ± $404.7 SD for LOVIT vs. $43,681.7 ± $8,853.6 SD for BRC, p < 0.0001). Thus, the BRC cost $38,627.3 per patient more than the LOVIT programme (95% CI: $17,414 to $273,482). There was a greater improvement in overall visual ability, mobility, and visual motor skill scores for BRC patients; however, there was no significant difference in improvement in reading ability or visual information processing scores. Conclusions: As VA increases outpatient blind rehabilitation services, LOVIT provides a model for expanding outpatient low-vision rehabilitation services for veterans at substantially lower costs than current inpatient BRC services.