Economic evaluation of blind rehabilitation for veterans with macular diseases in the Department of Veterans Affairs.
OBJECTIVE
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.
Stroupe
Kevin T
KT
Veterans Affairs Cooperative Studies Program Coordinating Center, Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois 60141, USA. Kevin.Stroupe@va.gov
Stelmack
Joan A
JA
Tang
X Charlene
XC
Reda
Domenic J
DJ
Moran
D'Anna
D
Rinne
Stephen
S
Mancil
Rickilyn
R
Wei
Yongliang
Y
Cummings
Roger
R
Mancil
Gary
G
Ellis
Nancy
N
Massof
Robert W
RW
D000203:Activities of Daily Living; D000368:Aged; D001766:Blindness / Q000191:economics* / Q000209:etiology / Q000534:rehabilitation*; D003365:Costs and Cost Analysis / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008268:Macular Degeneration / Q000150:complications / Q000191:economics*; D008297:Male; D015397:Program Evaluation / Q000191:economics* / Q000379:methods; D012047:Rehabilitation Centers / Q000191:economics*; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics*; D014728:Veterans; D014792:Visual Acuity