Dilated Eye Exams For Medicare Beneficiaries Cost Effective, USA

A study published Online First in the Archives of Ophthalmology, one of the JAMA/Archives journals, suggests that it "would be highly cost-effective" to replace visual acuity screenings for new Medicare enrollees with coverage of a dilated eye exam for healthy patients who enter the government insurance program for the elderly.
At the age of 65 years, individuals are able to enroll in Medicare. As part of a Welcome to Medicare health evaluation ,within 12 months of enrollment, they are supposed to receive a visual acuity screening and other preventive health checks. The U.S. Preventive Services Task Force reversed its 1996 recommendation in 2009, in favor of visual acuity screening, because of insufficient evidence to support it. At present, it is undecided whether Medicare will continue to include visual acuity screening in its initial preventive physical examination.
The researchers comment:

"Our results support the conclusions of the U.S. Preventive Services Task Force that currently recommended visual acuity screening in primary care settings cannot be demonstrated to result in meaningfully different outcomes than no screening."

David B. Rein, Ph.D., of Public Health Research at NORC at the University of Chicago, and his team, gathered data on 50,000 simulated patients who matched demographic characteristics to 65 year olds. They used a Monte Carlo cost-effectiveness simulation model and excluded patients with diabetes, given that the cost-effectiveness of visual screening for these patients has been established and also excluded those with diagnosed eye disease.
The findings indicate that dilated eye evaluations increased quality-adjusted life years (QALYs) by 0.008 and increased costs by $94, when compared with a no-screening policy. The researchers established that visual acuity screening raised QALYs in less than 95% of the simulations with an increase in total costs of $32 per person.
They conclude:

"Our research suggests that the current policy of visual acuity screening is a suboptimal use of resources and that replacing this policy with coverage of a dilated eye evaluation for all healthy patients entering Medicare would be highly cost-effective."

Writen by Petra Rattue
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