233909 Cost-Effectiveness of a ‘Welcome to Medicare' Style Expanded Visual Screening Exam

Monday, November 8, 2010 : 12:33 PM - 12:47 PM

David Rein, PhD , Public Health Economics Program, RTI International, Atlanta, GA
John S. Wittenborn, BS , Public Health Economics Program, RTI International, Atlanta, GA
Xinzhi Zhang, MD, PhD , Vision Health Initiative, Centers for Disease Control and Prevention, Atlanta, GA
Sarah B. Lesesne, BS , Public Health Economics Program, RTI International, Atlanta, GA
Jinan B. Saaddine, MD, MPH , National Vision Program, Centers for Disease Control and Prevention, Atlanta, GA
Beginning in 2005, Medicare instituted reimbursement for preventive physical examinations, including visual acuity screening, of all newly enrolled patients within their first year of enrollment. Policy makers have also considered the possibility of a companion ‘Welcome to Medicare' comprehensive eye exam to identify progressive asymptomatic visual disorders before they result in vision loss. Given current resource constraints, the future of these screening programs is unknown and their value sometimes questioned. In this paper we used a simulation model of five major eye disorders, age-related macular degeneration, diabetic retinopathy, glaucoma, and nuclear cataracts to test the incremental cost-effectiveness of existing Welcome to Medicare visual acuity screening compared to the rates of screening expected without the program, and of comprehensive eye examinations compared to simple acuity screening. We measured cost-effectiveness in terms of the incremental net benefit of screening evaluated at a range of willingness to pay values per day of impaired functionality averted. We used probabilistic sensitivity analysis and bootstrapping with replacement to estimate Bayesian credible intervals for each of our key model outputs. Because current utilization of the ‘Welcome to Medicare' screening is so low (3.2% in 2007), we performed threshold analyses of recruitment costs to determine how spending additional resources to raise utilization would impact cost-effectiveness. The results of these analyses can be used by policy makers to help prioritize visual health screening efforts with other Medicare policies.

Learning Areas:
Provision of health care to the public

Learning Objectives:
1. Describe the relevant Medicare policy that covers reimbursement for visual screening 2. Describe the US Preventive Task Force’s revision of earlier statements recommending screening for older adults 3. List the reasons for this revision. 4. Discuss the CDC/RTI-Multiple Eye Disease Simulation (C/R-MEDS) Model and 5. List the benefits in terms of measuring the cost effectiveness of comprehensive visual health examinations.

Keywords: Access and Services, Elderly

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: David Rein, PhD, is a senior research economist in RTI's Public Health Economics program. He develops cost-effectiveness and disease burden simulation models for public health decision making. Dr. Rein has worked in RTI's Public Health Economics program since completing his graduate degree in 2003. He has extensive experience with quantitative and qualitative research methods, and is an author of more than 25 peer reviewed publications. Over the last five years, Rein has led a joint CDC/RTI International project to develop the Multiple Eye Disease Simulation (CR-MEDS) model; a model of six major eye disorders that can be used to estimate the true benefits of public health visual screening.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.