Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using ...exemplars in Australia and China.
We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% annual discounting, where discounting adjusts future costs to 2020 value.
Low-dose atropine, antimyopia spectacles, antimyopia multifocal soft contact lenses and orthokeratology met our AMM inclusion criteria. Lifetime cost for TMM with 3% discounting was US$7437 (CI US$4953 to US$10 740) in Australia and US$8006 (CI US$3026 to US$13 707) in China. The lowest lifetime cost options with 3% discounting were antimyopia spectacles (US$7280, CI US$5246 to US$9888) in Australia and low-dose atropine (US$4453, CI US$2136 to US$9115) in China.
Financial investment in AMM during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Our methodology can be applied to estimate cost in comparable scenarios.
Background
A growing number of women with sporadic unilateral, early-stage breast cancers are undergoing ipsilateral therapeutic mastectomy with contralateral prophylactic mastectomy (CPM) to prevent ...the development of new cancers in the contralateral breast.
Methods
A decision-tree using TreeAge Pro 2012 software was used to model the costs and effects of CPM versus unilateral mastectomy (UM) in women younger than 50 years of age with sporadic unilateral, early stage breast cancers. Cost estimates were obtained from the Medicare Fee Schedule and the Healthcare Utilization Project. Probability estimates were obtained from the literature. Outcome effects were measured by incremental cost per quality-adjusted life year (QALY) gained. A 10-year risk period for contralateral breast cancer (CBC), a lifetime time horizon, and a societal perspective were used.
Results
Treatment with CPM results in 0.2 QALYs less than UM and $279 less in costs during a 10-year risk period and lifetime follow-up. The resulting incremental cost effectiveness ratio (ICER) is a savings of $1397 per QALY lost. The ICER is sensitive to the rate and method of postmastectomy reconstruction and the cost of radiologic surveillance after UM.
Conclusions
CPM is cost-saving for the prevention of CBC in women younger than 50 years of age with sporadic, unilateral, early-stage breast cancers, but also reduces resulting health. The savings for health lost are insufficient to be considered cost-effective at this time.
Hearing impairment (HI) is highly prevalent in older adults and has been associated with adverse health outcomes. However, the overall economic impact of HI is not well described.
The goal of this ...review was to summarize available data on all relevant costs associated with HI among adults.
A literature search of PubMed, Embase, the Cochrane Library, CINAHL, and Scopus was conducted in August 2015. For this systematic review, data extraction and quality assessment were performed by 2 independent reviewers. Eligibility criteria for included studies were presence of quantitative estimation of economic impact or loss of productivity of patients with HI, full-text English-language access, and publication in an academic, peer-reviewed journal or government report prior to August 2015. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. A meta-analysis was not performed owing to the studies' heterogeneity in outcomes measures, methodology, and study country.
The initial literature search yielded 4595 total references. After 2043 duplicates were removed, 2552 publications underwent title and abstract review, yielding 59 articles for full-text review. After full-text review, 25 articles were included. Of the included articles, 8 incorporated measures of disability; 5 included direct estimates of medical expenditures; 8 included other cost estimates; and 7 were related to noise-induced or work-related HI. Estimates of the economic cost of lost productivity varied widely, from $1.8 to $194 billion in the United States. Excess medical costs resulting from HI ranged from $3.3 to $12.8 billion in the United States.
Hearing loss is associated with billions of dollars of excess costs in the United States, but significant variance is seen between studies. A rigorous, comprehensive estimate of the economic impact of hearing loss is needed to help guide policy decisions around the management of hearing loss in adults.
Objective
To determine the relationship between frailty and comorbidity, in‐hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) ...surgery.
Study Design
Cross‐sectional analysis.
Methods
Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross‐tabulations and multivariate regression modeling. Frailty was defined based on frailty‐defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty‐defining diagnosis indicator.
Results
Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio OR = 1.51.3–1.8), Medicaid (OR = 1.51.3–1.8), major procedures (OR = 1.61.4–1.8), flap reconstruction (OR = 1.71.3–2.1), high‐volume hospitals (OR = 0.70.5–1.0), discharge to a short‐term facility (OR = 4.42.9–6.7), or other facility (OR = 5.44.5–6.6). Frailty was a significant predictor of in‐hospital death (OR = 1.61.1–2.4), postoperative surgical complications (OR = 2.01.7–2.3), acute medical complications (OR = 3.93.2–4.9), increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.
Conclusion
Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.
Level of Evidence
2c. Laryngoscope, 128:102–110, 2018
To assess how the returns on investment from correcting refractive errors and cataracts in low- and middle-income countries compare with the returns from other global development interventions.
We ...adopted two complementary approaches to estimate benefit-cost ratios from eye health investment. First, we systematically searched PubMed® and Web of Science™ on 14 August 2023 for studies conducted in low-and-middle-income countries, which have measured welfare impacts associated with correcting refractive errors and cataracts. Using benefit-cost analysis, we compared these impacts to costs. Second, we employed an economic modelling analysis to estimate benefit-cost ratios from eye health investments in India. We compared the returns from eye health to returns in other domains across global health and development.
We identified 21 studies from 10 countries. Thirteen outcomes highlighted impacts from refractive error correction for school students. From the systematic review, we used 17 out of 33 outcomes for benefit-cost analyses, with the median benefit-cost ratio being 36. The economic modelling approach for India generated benefit-cost ratios ranging from 28 for vision centres to 42 for school eye screening, with an aggregate ratio of 31. Comparing our findings to the typical investment in global development shows that eye health investment returns six times more benefits (median benefit-cost ratio: 36 vs 6).
Eye health investments provide economic benefits with varying degrees based on the intervention type and location. Our findings underline the importance of incorporating eye health initiatives into broader development strategies for substantial societal returns.
Objectives/Hypothesis:
The past 2 decades have witnessed an increase in the use of chemoradiation in the treatment of laryngeal cancer. We sought to characterize contemporary patterns of laryngeal ...cancer surgical care and the effect of volume status on surgical care and short‐term outcomes.
Study Design:
Retrospective cross‐sectional study.
Methods:
Using the Nationwide Inpatient Sample database, temporal trends in laryngeal cancer surgical care were evaluated in 78,478 cases performed in 1993 to 2008. Relationships between volume and mortality, complications, length of stay, and costs were evaluated in 24,856 cases performed in 2003 to 2008 using regression analysis, with adjustment for patient and provider characteristics.
Results:
Laryngeal cancer surgery in 2001 to 2008 was associated with increased utilization of high‐volume hospitals (odds ratio OR = 2.0, P = .039), a decrease in partial and total laryngectomy procedures (OR = 0.7, P < .001), an increase in flap reconstruction (OR = 1.6, P < .001), prior radiation (OR = 2.2, P < .001), comorbidity (OR = 1.6, P < .001), and wound complications (OR = 4.0, P < .001), compared to 1993 to 2000. High‐volume hospitals were significantly associated with partial laryngectomy (OR = 1.8, P = .026) and flap reconstruction (OR = 1.8, P = .027). High‐volume surgeons were associated with partial laryngectomy (OR = 1.7, P = .048), flap reconstruction (OR = 1.6, P = .029), prior radiation (OR = 2.2, P = .013), and comorbidity (OR = 0.4, P = .008). After controlling for all other variables, a statistically significant negative correlation was observed between surgery at a high‐volume hospital and length of hospitalization, and surgery by a high‐volume surgeon was associated with even greater reductions in length of hospitalization as well as lower hospital‐related costs.
Conclusions:
These data reflect changing trends in the primary management of laryngeal cancer, with meaningful differences in the type of surgical care provided by high‐volume providers.
In the absence of accessible, good quality eye health services and inclusive environments, vision loss can impact individuals, households and communities in many ways, including through increased ...poverty, reduced quality of life and reduced employment. We aimed to estimate the annual potential productivity losses associated with reduced employment due to blindness and moderate and severe vision impairment (MSVI) at a regional and global level.
We constructed a model using the most recent economic, demographic (2018) and prevalence (2020) data. Calculations were limited to the working age population (15–64 years) and presented in 2018 US Dollars purchasing power parity (ppp). Two separate models, using Gross Domestic Product (GDP) and Gross National Income (GNI), were calculated to maximise comparability with previous estimates.
We found that 160.7 million people with MSVI or blindness were within the working age and estimated that the overall relative reduction in employment by people with vision loss was 30.2%. Globally, using GDP we estimated that the annual cost of potential productivity losses of MSVI and blindness was $410.7 billion ppp (range $322.1 - $518.7 billion), or 0.3% of GDP. Using GNI, overall productivity losses were estimated at $408.5 billion ppp (range $320.4 - $515.9 billion), 0.5% lower than estimates using GDP.
These findings support the view that blindness and MSVI are associated with a large economic impact worldwide. Reducing and preventing vision loss and developing and implementing strategies to help visually impaired people to find and keep employment may result in significant productivity gains
MJB is supported by the Wellcome Trust (207472/Z/17/Z). JR's appointment at the University of Auckland is funded by the Buchanan Charitable Foundation, New Zealand. The Lancet Global Health Commission on Global Eye Health was supported by grants from The Queen Elizabeth Diamond Jubilee Trust, Moorfields Eye Charity (GR001061), NIHR Moorfields Biomedical Research Centre, The Wellcome Trust, Sightsavers, The Fred Hollows Foundation, The SEVA Foundation, The British Council for the Prevention of Blindness and Christian Blind Mission. The funders had no role in the design, conduct, data analysis of the study, or writing of the manuscript.
We estimated the potential global economic productivity loss resulting from vision impairment (VI) and blindness as a result of uncorrected myopia and myopic macular degeneration (MMD) in 2015.
...Understanding the economic burden of VI associated with myopia is critical to addressing myopia as an increasingly prevalent public health problem.
We estimated the number of people with myopia and MMD corresponding to critical visual acuity thresholds. Spectacle correction coverage was analyzed against country-level variables from the year of data collection; variation in spectacle correction was described best by a model based on a human development index, with adjustments for urbanization and age. Spectacle correction and myopia data were combined to estimate the number of people with each level of VI resulting from uncorrected myopia. We then applied disability weights, labor force participation rates, employment rates, and gross domestic product per capita to estimate the potential productivity lost among individuals with each level and type of VI resulting from myopia in 2015 in United States dollars (US$). An estimate of care-associated productivity loss also was included.
People with myopia are less likely to have adequate optical correction if they are older and live in a rural area of a less developed country. The global potential productivity loss associated with the burden of VI in 2015 was estimated at US$244 billion (95% confidence interval CI, US$49 billion-US$697 billion) from uncorrected myopia and US$6 billion (95% CI, US$2 billion-US$17 billion) from MMD. Our estimates suggest that the Southeast Asia, South Asia, and East Asia Global Burden of Disease regions bear the greatest potential burden as a proportion of their economic activity, whereas East Asia bears the greatest potential burden in absolute terms.
Even under conservative assumptions, the potential productivity loss associated with VI and blindness resulting from uncorrected myopia is substantially greater than the cost of correcting myopia.
Objective Health care costs are disproportionately concentrated among a small number of patients. We sought to identify variables associated with high‐cost patients and high hospital concentration of ...high‐cost patients and to examine associations with short‐term outcomes in head and neck cancer (HNCA) surgery. Study Design The Nationwide Inpatient Sample was used to identify 170,577 patients who underwent HNCA surgery in 2001–2011. High‐cost patients were defined as patients whose costs of care were in the top decile, and high‐concentration hospitals were defined as those whose percentage of high‐cost patients was in the top decile. Methods Multivariable regression was used to evaluate associations between cost and patient and hospital variables, postoperative complications, and in‐hospital mortality. Results Costs associated with high‐cost patients were 4.47‐fold greater than the remaining 90% of patients. High‐concentration hospitals treated 36% of all high‐cost patients. High‐cost patients were more likely to be non‐white (OR = 2.08 1.45–2.97), have oral cavity cancer (OR = 1.21 1.05–1.39), advanced comorbidity (OR = 1.53 1.31–1.77), Medicaid (OR = 1.93 1.62–2.31) or self‐pay payor status (OR = 1.72 1.38–2.14), income>50th percentile (OR = 1.25 1.05–1.51), undergo major procedures (OR = 3.52 3.07–4.05) and have non‐routine discharge (OR = 7.50 6.01–9.35). High‐concentration hospitals were more likely to be teaching hospitals (OR = 3.14 1.64–6.05) and less likely to be urban (OR = 0.20 0.04–0.93). After controlling for all other variables, high‐cost patients were associated with an increased odds of mortality (OR = 8.00 5.89–10.85) and postoperative complications (OR = 5.88 5.18–6.68). High‐concentration hospitals were associated with an increased odds of postoperative complications (OR = 1.31 1.08–1.61) but were not associated with increased mortality (OR = 0.98 0.67–1.44). Conclusions High‐cost HNCA surgical patients are associated with increased postoperative morbidity and mortality, and are disproportionately concentrated at teaching hospitals. Level of Evidence 4 Laryngoscope , 2024
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