Improve Vision, Make Money

American Academy of Ophthalmology 2013

Melissa M. Brown, MD, MN, MBA


November 26, 2013

Editorial Collaboration

Medscape &

In This Article

Improving Utility: Better Vision and Patient Value

The methodology is called "utility analysis," and we use it to compare QOL for all health states across all fields of medicine, not just ophthalmology. The ability to assess quality-of-life changes in patients within this methodology -- it is all-encompassing. You don't have to worry about having patients not count certain things such as their concern for their life or their concern for their family's well-being. Last, we can use utility analysis in economic analyses, which is very important to me. The anchors in utility analysis and the measurement start from 0.0, which represents the worst health (in this case death), to 1.0, which is perfect health. In this case that would be 20/20 vision in both eyes.

If you line up the mean utilities that we have found after evaluating thousands of patients, they line up pretty linearly from the health state of no light perception to light perception. The health state of no light perception is about 0.3 on a scale from 0 to 1, and it ranges all the way up to 1.0 for someone who permanently has 20/20 vision. We are looking at how we can document the improvement in QOL that is gained by our interventions.

Today we are going to be talking about cataract surgery. We take our total patient value gained, and that is found out from the improvement in the utility. Taking someone from 20/80 to 20/20 improves their utility. The utility gain multiplied by the duration of the benefit (for example, the 13 years that someone is going to live after that cataract and have that better QOL) gives an objective measure called a quality-adjusted life year (QALY). Given that background, let's revisit cataract surgery to assess the patient value gained and the financial value gained -- which you are going to find as fascinating as I did -- from cataract surgery.