Financial Return-on-Investment of Ophthalmic Interventions

A New Paradigm

Melissa M. Brown; Gary C. Brown; Heidi B. Lieske; P. Alexander Lieske

Disclosures

Curr Opin Ophthalmol. 2014;25(3):171-176. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Although the patient value gain (improvement in quality-of-life and/or length-of-life) has been highlighted in Value-based Medicine cost–utility analyses, the financial value gain associated with healthcare interventions has received less emphasis. It is important for professional healthcare providers to realize their interventions often confer a large financial return-on-investment (ROI) to society.

Recent findings: The societal costs associated with vitreoretinal and other ophthalmic interventions include: direct ophthalmic medical costs expended (hospital, physician, drug, diagnostic testing and so forth), direct medical costs saved (decreased costs for depression, injury, skilled nursing facility, nursing home and others), direct nonmedical costs saved (decreased costs for caregivers, transportation, residence costs, moving costs, and others), and indirect medical costs saved (improving employment incidence and wages). The financial ROI for direct ophthalmic medical costs expended for ranibizumab therapy for neovascular age-related macular degeneration is 450%, whereas that for cataract surgery is 4500% and for medical open-angle glaucoma therapy is 4000%. Many costs gained add to the Gross Domestic Product and increase the wealth of the nation.

Summary: Many vitreoretinal and other ophthalmologic interventions confer considerable patient value, but also result in a large financial ROI to society. This financial ROI increases the wealth of the nation.

Introduction

Value-based Medicine is the practice of medicine based upon the patient value and financial value conferred by healthcare interventions.[1–4] Patient value is defined by the improvement in quality-of-life and/or length-of-life gained from an intervention. Numerous previous publications have shown that vitreoretinal and other ophthalmic interventions deliver great patient value.[1–4]

Nonetheless, much less has been written to date about financial value associated with vitreoretinal and other ophthalmic interventions. This article addresses the costs that are saved by vitreoretinal and other ophthalmic interventions, many of which are considerable and increase the wealth of the nation.[4] Variants of these types of costs are also likely applicable across all specialties of medicine. The authors believe the financial value created by healthcare interventions will assume the importance it deserves in the healthcare equation in the 21st Century.

Conventionally, the medical costs associated with a healthcare interventions are the direct medical costs expended for the intervention.[1–5] Among the direct medical costs are those expended for facilities, physicians, drugs, laboratory testing, rehabilitation and others. A list of the overall direct medical cost expenditures is shown in Table 1 .[5] Direct medical costs across healthcare are projected to rise 6.1% in 2014 by the actuaries at the Centers for Medicare and Medicaid Services.[5]

Although the direct medical costs expended for a healthcare intervention are the most visible, multiple other costs are associated with healthcare interventions. Included among these are the direct medical costs saved by an intervention, the direct nonmedical costs saved from an intervention and the indirect medical costs saved as a result of the intervention.[4] A discussion of these costs and their relationship to vitreoretinal and other ophthalmologic interventions follows.

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