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Research Interests: Health Services Research, Medicine, Comorbidity, Logistic Regression, Humans, and 15 moreGlaucoma, Female, Male, Cohort, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Optometry and Ophthalmology, Adult, Public health systems and services research, Risk Factors, Health Care Costs, Delivery of Health Care, and Health Resources
Research Interests: Medicine, Population, Demographics, Migraine, Headache, and 3 moreClinical Sciences, Preference, and Dosing
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Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature. To compare current textbook... more
Chronic aortic regurgitation can lead to significant morbidity and mortality. For more than a century, numerous eponymous signs of aortic regurgitation have been described in textbooks and the literature. To compare current textbook content with the peer-reviewed literature on the eponymous signs of aortic regurgitation and to assess the role of these signs in clinical practice. 11 textbooks, MEDLINE (1966 through October 2002), and bibliographies of textbooks and relevant papers. English-language reports that were related to the properties of a sign on physical examination, incorporated more than 10 adults, and did not involve prosthetic heart valves or acute aortic regurgitation. Three investigators independently analyzed relevant textbook extracts and 27 reports, using predetermined qualitative review criteria. Data relating to diagnostic accuracy and properties of the index test were also extracted. Twelve eponymous signs were described as having varying degrees of importance by textbook authors. Only the Austin Flint murmur, the Corrigan pulse, the Duroziez sign, and the Hill sign had sufficient original literature for detailed review. Most reports were low quality, with varying sensitivities for all signs. Except for the Hill sign, specificity tended to be poor. Evidence for the Hill sign also suggested a correlation between the popliteal-brachial gradient and aortic regurgitation severity. Prominent textbook support of the eponymous signs of aortic regurgitation is not matched by the literature. Clinicians and educators should update and improve the evidence for these signs to ensure their relevance in current medical practice.
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Patients with neurogenic orthostatic hypotension (nOH) due to autonomic dysfunction may also experience supine hypertension (defined as supine systolic blood pressure [SBP] ≥140 mmHg). Because pressor agents used to improve nOH symptoms... more
Patients with neurogenic orthostatic hypotension (nOH) due to autonomic dysfunction may also experience supine hypertension (defined as supine systolic blood pressure [SBP] ≥140 mmHg). Because pressor agents used to improve nOH symptoms by increasing standing blood pressure (BP) may exacerbate or cause supine hypertension, changes in supine BP with nOH treatments are of interest.
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Many policy makers believe that health status would be improved and health care spending reduced if people managed their health better. This study examined the effectiveness of a program put in place by BJC HealthCare, a hospital system... more
Many policy makers believe that health status would be improved and health care spending reduced if people managed their health better. This study examined the effectiveness of a program put in place by BJC HealthCare, a hospital system based in St. Louis, Missouri, that tied employees’ eligibility to participate in the system’s most generous health plan with participation in a wellness program. The intervention, which began in 2005, was associated with a 41 percent decrease, relative to a comparison group, in hospitalizations for conditions targeted by the wellness program but with no significant decrease in other hospitalizations. We found reductions in inpatient costs but similar increases in non-inpatient costs. Therefore, we conclude that although the program did cut some hospitalizations, it did not save money for the employer in the short term. This finding underscores that wellness program incentives under the Affordable Care Act are unlikely to greatly reduce health care sp...
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4738 Introduction: High-dose chemotherapy in conjunction with autologous peripheral stem cell transplantation (ASCT) has emerged as a preferred treatment modality for a variety of relapsed hematological malignancies including non-Hodgkin... more
4738 Introduction: High-dose chemotherapy in conjunction with autologous peripheral stem cell transplantation (ASCT) has emerged as a preferred treatment modality for a variety of relapsed hematological malignancies including non-Hodgkin lymphoma (NHL). Failure rates with current mobilization regimens are estimated to be between 5% and 30%. This failure adds substantially to the cost of this already costly procedure due to the need for multiple apheresis sessions following initial mobilization, as well as the implementation of costly rescue protocols. An additional economic burden of this reduced efficacy is increased mortality as fewer patients proceed to transplantation. Plerixafor with G-CSF (G+P) has been shown to be superior to G-CSF (G) alone for stem cell mobilization in heavily pretreated patients with NHL. This increased efficacy reduces the required number of apheresis sessions, reduces the likelihood of rescue, and increases the likelihood of successful engraftment, all o...
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Research Interests: Program Evaluation, Pharmacy, Medication Adherence, Medicine, Humans, and 10 moreFemale, Male, Middle Aged, Public health systems and services research, Retrospective Studies, Guidance and Counseling Intervention Programs, Pilot Projects, service Business, Specialty, and Pharmacology and pharmaceutical sciences
Research Interests: Clinical Trial, Medicine, Applied Economics, Glaucoma, Chronic Disease, and 12 moreCost effectiveness, Public health systems and services research, Randomized Controlled Trial, Analytical Model, Disease Progression, Visual Field, Prospective Study, Predictive value of tests, Markov model, Data Gathering, Mean Deviation, and transition probability
Research Interests: Ophthalmology, Quality of life, Medicine, Macular Degeneration, Refractive Error, and 15 moreHumans, Glaucoma, Diabetic Retinopathy, Female, Male, Cataract, Clinical Sciences, Aged, Middle Aged, Optometry and Ophthalmology, Adult, Public health systems and services research, Observational Study, Refractive Errors, and Cross Sectional Studies
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Research Interests: Optometry, Health Services Research, Medicine, Comorbidity, Humans, and 15 moreMarkov chains, Glaucoma, Female, Male, American, Medicare, Clinical Sciences, Aged, Health Expenditures, Optometry and Ophthalmology, Public health systems and services research, Cost of Illness, Health Care Costs, Primary Open Angle Glaucoma, and Decision Support Techniques
Research Interests: Ophthalmology, Medicine, Lipids, Humans, Glaucoma, and 12 moreIntraocular Pressure, Cost effectiveness, Clinical Sciences, Optometry and Ophthalmology, Amides, Public health systems and services research, Cost Benefit Analysis, Drug Costs, Ocular Hypertension, Randomized Controlled Trials as Topic, Antihypertensive agents, and bimatoprost
Research Interests: Binocular vision, Quality of life, Medicine, Visual acuity, Humans, and 12 moreKeratoconus, Female, Male, American, Clinical Sciences, Questionnaires, Optometry and Ophthalmology, Adult, Public health systems and services research, Cross sectional Study, Cross Sectional Studies, and health status indicators
To evaluate the incidence of epithelial defects in patients who have had laser in situ keratomileusis (LASIK) surgery with the standard compression Hansatome microkeratome head in comparison to the modified (zero-compression) Hansatome... more
To evaluate the incidence of epithelial defects in patients who have had laser in situ keratomileusis (LASIK) surgery with the standard compression Hansatome microkeratome head in comparison to the modified (zero-compression) Hansatome microkeratome head (Bausch & Lomb, Rochester, NY). This study was a retrospective review of 404 consecutive patients who had LASIK surgery on both eyes between January 2002 and June 2002. The standard compression microkeratome head was used in 216 (53%) cases and the zero-compression microkeratome head was used in 188 (47%) cases. Epithelial defects were categorized as loose epithelium, or a break in the epithelium, within the area of the flap. An adverse outcome for a patient was defined as having an epithelial defect in at least one eye. Odds ratios were estimated using logistic regression. When the standard compression microkeratome head was used, 19 (8.8%) patients had an epithelial defect in at least 1 eye. When the zero-compression microkeratome...
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OBJECTIVES Automatic prescription refill programs are a popular means of improving medication adherence. A concern is the potential for prescription drug wastage and unnecessary healthcare spending. We evaluated the impact of an automatic... more
OBJECTIVES Automatic prescription refill programs are a popular means of improving medication adherence. A concern is the potential for prescription drug wastage and unnecessary healthcare spending. We evaluated the impact of an automatic refill program on patterns of medication use. STUDY DESIGN Retrospective propensity score matched cohort study with multivariable generalized linear modeling. METHODS The setting of the study was a pharmacy benefit manager administering benefits for patients of retail pharmacies. Participants included patients on medication for chronic conditions; those receiving a 30-day supply (n = 153,964) and a 90-day supply (n = 100,394) were analyzed separately. The intervention was the automatic prescription refill program. Measures included medication possession ratio (MPR) and average days excess at the time of refill. The results are reported across 11 therapeutic classes. RESULTS Overall, patients receiving 30-day supplies of medication in the automatic ...
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Abstract Aims: There have been no systematic literature reviews (SLRs) evaluating the identified association between outcomes (e.g. clinical, functional, adherence, societal burden) and Quality-of-Life (QoL) or Healthcare Resource... more
Abstract Aims: There have been no systematic literature reviews (SLRs) evaluating the identified association between outcomes (e.g. clinical, functional, adherence, societal burden) and Quality-of-Life (QoL) or Healthcare Resource Utilization (HCRU) in schizophrenia. The objective of this study was to conduct a SLR of published data on the relationship between outcomes and QoL or HCRU. Materials and methods: Electronic searches were conducted in Embase and Medline, for articles which reported on the association between outcomes and QoL or HCRU. Inclusion and exclusion criteria were applied to identify the most relevant articles and studies and extract their data. A summary table was developed to illustrate the strength of associations, based on p-values and correlations. Results: One thousand and two abstracts were retrieved; five duplicates were excluded; 997 abstracts were screened and 95 references were retained for full-text screening. Thrirty-one references were included in the review. The most commonly used questionnaire, which also demonstrated the strongest associations (defined as a p < 0.0001 and/or correlation ±0.70), was the Positive and Negative Syndrome Scale (PANSS) associated with HCRU and QoL (the SF-36, the Schizophrenia Quality-of-Life questionnaire [S-QOL-18], the Quality-of-Life Scale [QLS]). Other robust correlations included the Clinical Global Impression–Severity (CGI-S) with QoL (EQ5D), relapse with HCRU, and remission with QoL (EQ5D). Lastly, functioning (Work Rehabilitation Questionnaire [WORQ] and Personal and Social Performance Scale [PSP]) was found to be associated to QoL (QLS and Subjective Well-being under Neuroleptics Questionnaire [SWN]). Limitations: This study included data from an 11-year period, and other instruments less frequently used may be further investigated. Conclusions: The evidence suggests that the PANSS is the clinical outcome that currently provides the most frequent and systematic associations with HCRU and QoL endpoints in schizophrenia.
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Medication discrepancies at the time of hospital discharge are common and can harm patients. Medication reconciliation by pharmacists has been shown to prevent such discrepancies and the adverse drug events (ADEs) that can result from... more
Medication discrepancies at the time of hospital discharge are common and can harm patients. Medication reconciliation by pharmacists has been shown to prevent such discrepancies and the adverse drug events (ADEs) that can result from them. Our objective was to estimate the economic value of nontargeted and targeted medication reconciliation conducted by pharmacists and pharmacy technicians at hospital discharge versus usual care. Discrete-event simulation model. We developed a discrete-event simulation model to prospectively model the incidence of drug-related events from a hospital payer's perspective. The model assumptions were based on data published in the peer-reviewed literature. Incidences of medication discrepancies, preventable ADEs, emergency department visits, rehospitalizations, costs, and net benefit were estimated. The expected total cost of preventable ADEs was estimated to be $472 (95% credible interval [CI], $247-$778) per patient with usual care. Under the bas...
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To assess the impact of CVS Health's discontinuation of tobacco sales on cigarette purchasing. We used households' purchasing data to assess rates at which households stopped cigarette purchasing for at least 6 months during... more
To assess the impact of CVS Health's discontinuation of tobacco sales on cigarette purchasing. We used households' purchasing data to assess rates at which households stopped cigarette purchasing for at least 6 months during September 2014 to August 2015 among 3 baseline groups: CVS-exclusive cigarette purchasers, CVS+ (CVS and other retailers), and other-exclusive (only non-CVS retailers). In state-level analyses using retailers' point-of-sale purchase data, an interrupted time series compared cigarette purchasing before (January 2012 to August 2014) and after (September 2014 to April 2015) tobacco removal in 13 intervention states with CVS market share of at least 15% versus 3 control states with no CVS stores. Compared with other-exclusive purchasers, CVS-exclusive purchasers were 38% likelier (95% confidence interval = 1.06, 1.81) to stop cigarette purchasing after tobacco removal. Compared with control states, intervention states had a significant mean decrease of 0...
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Some experts recommend increasing low rates of follow-up after cataract surgery in low- and middle-income countries using various interventions. However, little is known about the cost and effect of such interventions. To examine whether... more
Some experts recommend increasing low rates of follow-up after cataract surgery in low- and middle-income countries using various interventions. However, little is known about the cost and effect of such interventions. To examine whether promoting follow-up after cataract surgery creates economic value. The Prospective Review of Early Cataract Outcomes and Grading (PRECOG) is a cohort study with data from patients undergoing cataract surgery from January 19, 2010, to April 18, 2012. Final follow-up was completed on August 10, 2012. Data were collected before surgery, at discharge, and at follow-up at least 40 days after surgery from 27 centers in 8 countries in Asia, Africa, and Latin America. Each center enrolled 40 to 120 consecutive patients undergoing cataract surgery. If patients did not return to the hospital for the follow-up visit, hospitals could use telephone calls or transportation subsidies to increase follow-up rate. Data were analyzed from December 2013 to January 2016...
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ABSTRACT Purpose: We used multi-attribute theory to develop a utility elicitation instrument for people with glaucoma based on the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ), a vision specific quality of life... more
ABSTRACT Purpose: We used multi-attribute theory to develop a utility elicitation instrument for people with glaucoma based on the National Eye Institute-Visual Functioning Questionnaire (NEI-VFQ), a vision specific quality of life instrument frequently used in clinical trials. We evaluated the construct validity of the instrument by comparing estimated utility values to glaucoma severity as measured by mean deviation (MD). Methods: NEI-VFQ responses from 99 patients with a range of glaucoma severity were analyzed qualitatively to identify the 12 items most responsive to visual field status. We then constructed a conjoint interview and administered it to 48 people with glaucoma, identifying the 6 items of greatest importance. With these results, we constructed a web-based interview using standard gamble (SG) and visual analog scales (VAS) and administered it to a community sample of 404 people. SG results were analyzed using regression methods and the VAS results were used to weight intermediate responses. We assessed validity by applying the weights to the NEI-VFQ responses of 709 participants and plotting these against MD. The instrument would be considered valid if greater disutility was associated with worse MD. Result: Disutility for people with glaucoma was determined to be measured by three items, with maximum utility loss shown in parentheses: being able to read normal print (0.11); having to stay home due to vision (0.125); and needing help with activities due to vision (0.036). The results of our construct validity analyses are presented in the accompanying table. As expected, utility loss was associated with increasing severity of disease in the best seeing-eye, indicating excellent construct validity. Conclusion: We have developed and validated an instrument that can be used to estimate the utility loss in people with glaucoma based upon the NEI-VFQ. When used in clinical trials, the instrument will provide an estimate of the utility loss associated with the progression of glaucoma, supporting cost-utility studies of glaucoma progression and preventions.
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ABSTRACT
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A growing body of published evidence exists on the risk factors for disease progression in pulmonary arterial hypertension (PAH). The Scientific Steering Committee for the Study of Risk in PAH was established to bring together leading... more
A growing body of published evidence exists on the risk factors for disease progression in pulmonary arterial hypertension (PAH). The Scientific Steering Committee for the Study of Risk in PAH was established to bring together leading clinical and statistical experts in PAH and risk modelling, for the purpose of advancing the understanding of the risk of development and progression of PAH. Herein, we discuss the impact of this information on three key areas: 1) clinical decision-making; 2) policy and reimbursement; and 3) future trials and research.
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Research Interests: Humans, United States, Female, Male, Length of Stay, and 12 moreClinical Sciences, Middle Aged, Health Expenditures, Tracheostomy, Intensive Care Units, Hospital Mortality, Respiratory Care, Acute Disease, quality assurance in health care, Patient discharge, Respiratory insufficiency, and Cardiovascular medicine and haematology
Osteoarthritis (OA) is a common and disabling disease. Because of improved treatment of chronic diseases and lower mortality from infectious diseases, the US population is aging, and older Americans are living with disabling conditions,... more
Osteoarthritis (OA) is a common and disabling disease. Because of improved treatment of chronic diseases and lower mortality from infectious diseases, the US population is aging, and older Americans are living with disabling conditions, including hip OA. The projected number of older adults with arthritis or other chronic musculoskeletal joint symptoms is expected to nearly double, from 21.4 million in 2005 to 41.1 million by 2030. The burden of hip OA is increasing due to the aging population and the obesity crisis; as a result, the need for total hip arthroplasty (THA) is expected to grow 174%, to 572,000 primary THAs per year by 2030 in the United States. Prior projections appear to have underestimated the actual number of primary and revision THAs that are in demand.
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Statistical models are in essence a collection of assumptions intended to model a natural process. Therefore, the reader's primary concern is how well those assumptions reflect reality, and how much influence changes in assumptions... more
Statistical models are in essence a collection of assumptions intended to model a natural process. Therefore, the reader's primary concern is how well those assumptions reflect reality, and how much influence changes in assumptions might make on the policy ...
Research Interests: Blindness, Medicine, Humans, Markov chains, Glaucoma, and 13 moreIntraocular Pressure, Clinical Sciences, Quality adjusted life years, Scotoma, Visual Fields, Laser Therapy, Sensitivity and Specificity, Trabeculectomy, Monte Carlo Method, Ocular Hypertension, Markov model, Antihypertensive agents, and Outcome assessment (Health care)
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Statistical models are in essence a collection of assumptions intended to model a natural process. Therefore, the reader's primary concern is how well those assumptions reflect reality, and how much influence changes in assumptions... more
Statistical models are in essence a collection of assumptions intended to model a natural process. Therefore, the reader's primary concern is how well those assumptions reflect reality, and how much influence changes in assumptions might make on the policy ...
Research Interests: Blindness, Medicine, Humans, Markov chains, Glaucoma, and 13 moreIntraocular Pressure, Clinical Sciences, Quality adjusted life years, Scotoma, Visual Fields, Laser Therapy, Sensitivity and Specificity, Trabeculectomy, Monte Carlo Method, Ocular Hypertension, Markov model, Antihypertensive agents, and Outcome assessment (Health care)
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To characterize the costs of caring for patients with open-angle glaucoma (OAG) in the United States over time and to identify factors that influence these costs. Longitudinal cohort study. Claims data from 19 927 newly diagnosed OAG... more
To characterize the costs of caring for patients with open-angle glaucoma (OAG) in the United States over time and to identify factors that influence these costs. Longitudinal cohort study. Claims data from 19 927 newly diagnosed OAG patients enrolled in a large United States managed care network were reviewed to identify glaucoma-related charges for all incident OAG patients from 2001 through 2009. Average glaucoma-related charges for enrollees with OAG were characterized in 6-month blocks from the date of initial OAG diagnosis through the ensuing 5 years. Factors associated with being an enrollee in the costliest 5% for glaucoma-related charges (accruing $5810 or more in charges in the first 2 years) were identified using logistic regression. The costliest 5% of enrollees were responsible for $10 202 871 (24%) of all glaucoma-related charges. By comparison, those whose costs fell within the lower 50% of the cost distribution collectively amassed only $7 986 582 (19%) of all glaucoma-related charges. A spike in glaucoma-related charges occurred in the 6-month period around the time of OAG diagnosis, stabilized by 1 year after diagnosis, and remained relatively constant over time. Risk factors associated with being in the costliest 5% for glaucoma-related care included younger age, Northeastern United States state residence, undergoing cataract surgery, and possessing ocular comorbidities (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .006 for all comparisons). A small subset of enrollees account for a large proportion of all glaucoma-related charges. Understanding the characteristics of these individuals and finding ways to reduce disease burden and costs associated with their care can result in substantial cost savings.
Research Interests: Health Services Research, Medicine, Comorbidity, Humans, United States, and 14 moreFemale, Male, Risk factors, Clinical Sciences, Aged, Middle Aged, Longitudinal Studies, Optometry and Ophthalmology, Adult, Public health systems and services research, Risk Factors, Health Care Costs, Delivery of Health Care, and Health Resources
To describe a systematic review of population-based prevalence studies of visual impairment (VI) and blindness worldwide over the past 32 years that informs the Global Burden of Diseases, Injuries and Risk Factors Study. A systematic... more
To describe a systematic review of population-based prevalence studies of visual impairment (VI) and blindness worldwide over the past 32 years that informs the Global Burden of Diseases, Injuries and Risk Factors Study. A systematic review (Stage 1) of medical literature from 1 January 1980 to 31 January 2012 identified indexed articles containing data on incidence, prevalence and causes of blindness and VI. Only cross-sectional population-based representative studies were selected from which to extract data for a database of age- and sex-specific data of prevalence of four distance and one near vision loss categories (presenting and best-corrected). Unpublished data and data from studies using rapid assessment methodology were later added (Stage 2). Stage 1 identified 14,908 references, of which 204 articles met the inclusion criteria. Stage 2 added unpublished data from 44 rapid assessment studies and four other surveys. This resulted in a final dataset of 252 articles of 243 studies, of which 238 (98%) reported distance vision loss categories. A total of 37 studies of the final dataset reported prevalence of mild VI and four reported near VI. We report a comprehensive systematic review of over 30 years of VI/blindness studies. While there has been an increase in population-based studies conducted in the 2000s compared to previous decades, there is limited information from certain regions (eg, Central Africa and Central and Eastern Europe, and the Caribbean and Latin America), and younger age groups, and minimal data regarding prevalence of near vision and mild distance VI.
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Economic evaluation in the form of reports of cost-effectiveness of the treatment and prevention of disease has only recently found widespread application in the visual sciences. While economic evaluation takes a number of forms:... more
Economic evaluation in the form of reports of cost-effectiveness of the treatment and prevention of disease has only recently found widespread application in the visual sciences. While economic evaluation takes a number of forms: cost-minimization analysis, cost-benefit analysis, and cost-effectiveness analysis--it is the latter that is seen most often in the evaluation of vision-related health programs. Cost-effectiveness analysis is in particular seen most commonly in its very particular form of cost-utility analysis. Decision analysis is the analytic method most commonly used to perform cost-effectiveness analysis. In decision analysis, the expected cost and effectiveness of a health program are estimated in a rigorous fashion. In this report, we take the reader through the process of decision analysis including building the tree; populating the model with parameters for risk, cost and benefit; estimating expected cost and benefit; and deterministic and probabilistic sensitivity analysis. Examples employed include prominent studies of the cost-effectiveness of photodynamic therapy for treatment of neovascular macular degeneration and the treatment ocular hypertension to prevent glaucoma.