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Letters |

The Economics of the Initial Preventive Physical Examination in Medicare—Reply

David Rein, PhD; John Wittenborn, BS
Arch Ophthalmol. 2012;130(9):1232-1234. doi:10.1001/archophthalmol.2012.1702.
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We appreciate the interest in our article expressed by Kymes et al. In response to their concerns, we report the univariate impact of changes in the sensitivity of the Welcome to Medicare vision test for detecting uncorrected refractive error (URE) and the potential value of information to be gained from additional research on this parameter. Using the model described in our article, we estimated the cost-effectiveness of Welcome to Medicare visual acuity screening compared with no screening using the parameter values drawn from the 5th and 95th percentiles of the distribution of the sensitivity of screening for the URE parameter (β distribution, mean = 0.7, α = 20.3, β = 8.7).1,2 Using these values, when compared with no screening, Welcome to Medicare visual acuity screening resulted in an incremental cost-effectiveness ratio of $34 500 per quality-adjusted life-year (QALY) gained when assuming a low sensitivity of 0.55 and an incremental cost-effectiveness ratio of $24 200 when assuming a high sensitivity of 0.83. Because the estimated upper bound of the credible interval of the incremental cost-effectiveness ratio of dilated eye examinations when compared with initial preventive physical examination (IPPE) visual acuity screening was $10 600, we conclude that IPPE screening would still be extendedly dominated by no screening and dilated eye examinations even at the upper end of its estimated distribution.

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Figure. Expected value of perfect parameter information (EVPPI) for the sensitivity of initial preventive physical examination visual acuity screening in detecting uncorrected refractive error (URE). QALY indicates quality-adjusted life-year; WTP, willingness to pay.

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September 1, 2012
Steven Kymes, PhD; Rohit Varma, MD, MPH; Anne L. Coleman, MD, PhD
Arch Ophthalmol. 2012;130(9):1232-1234. doi:10.1001/archophthalmol.2012.1217.
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