Showing papers by "Gary C. Brown published in 2002"
TL;DR: At similar levels of visual acuity loss, that associated with diabetic retinopathy causes a similar reduction in quality of life to that associated to age-related macular degeneration.
Abstract: Objective To compare the quality of life in patients with visual acuity loss occurring secondary to diabetic retinopathy with visual acuity loss occurring secondary to age-related macular degeneration (ARMD). Methods Consecutive patients with diabetic retinopathy and ARMD were evaluated using the time trade-off method of utility value analysis. Both groups were stratified according to the degree of visual acuity loss in the better-seeing eye (group 1: 20/20-20/25, group 2: 20/30-20/40, group 3: 20/50-20/100, group 4: ≤20/200). Utility values obtained from the patients, once stratified for visual acuity group, were compared with use of the t test and the Mann-Whitney U test. In addition, a 2-way analysis of variance was performed to control for potential confounding variables. Results No difference was found between the utility value means of the diabetic retinopathy (n = 333) and ARMD (n = 246) subgroups stratified according to visual acuity levels: group 1, P = .54; group 2, P = .96; group 3, P = .09; and group 4, P = .32. A 2-way analysis of variance demonstrated that, among the variables of ocular disease, sex, age, and visual acuity in the better-seeing eye, only visual acuity was significantly associated with utility values ( P = .003). Conclusions At similar levels of visual acuity loss, that associated with diabetic retinopathy causes a similar reduction in quality of life to that associated with ARMD. This information has important implications for use in cost-utility analyses of ophthalmic interventions.
190 citations
TL;DR: In this paper, a cost-utility analysis was performed from a third-party insurer perspective by using decision analysis, evidence-based data from the literature, and patient preference-based time trade-off utility values.
132 citations
TL;DR: Both the standard gamble and TTO methods demonstrate strong validity when evaluated against visual acuity in the better seeing eye and the VF-14 score.
Abstract: Aim: To assess the validity of the time trade-off (TTO) and standard reference gamble (SRG) techniques of utility assessment in patients with retinal disease. A cross section of eligible patients was studied and validity was determined through their relation with two logical constructs, visual acuity and scores from the Visual Function 14 (VF-14) index. Methods: The study consisted of eligible patients presenting to a tertiary retinal facility who completed an interview. All patients had best corrected vision of 20/40 or worse in at least one eye. TTO and SRG utilities, as well as a VF-14 questionnaire, were administered through a standardised interview. Demographic and clinical (including Snellen visual acuity) information was also collected. Results: 323 patients met these study criteria. Significant predictors of TTO utilities in the multivariate analysis were vision in the better seeing eye (p<0.01) and VF-14 scores (p<0.01). Significant predictors of standard gamble utilities were also vision in the better seeing eye (p<0.01) and VF-14 scores (p<0.05). Conclusion: Both the standard gamble and TTO methods demonstrate strong validity when evaluated against visual acuity in the better seeing eye and the VF-14 score.
109 citations
TL;DR: Quality of life with hypertension was judged to be significantly higher according to affected individuals (mean utility score, 0.980), compared with normotensive persons and clinicians and clinicians, who were asked to assume that they had hypertension.
Abstract: The authors evaluated the self-reported quality of life in patients with systemic arterial hypertension and assessed whether clinicians and normotensive respondents from the general public appreciate the impact that hypertension has on health-related quality of life. A quality-of-life questionnaire was completed by 385 individuals: persons with hypertension (n=188), normotensive persons (n=148), and clinicians (n=49). A utility score, which represents one's self-perceived health-related quality of life, was generated for each group by using standardized time tradeoff questionnaires. Quality of life with hypertension was judged to be significantly higher according to affected individuals (mean utility score, 0.980), compared with normotensive persons (mean utility score, 0.948) and clinicians (mean utility score, 0.942), who were asked to assume that they had hypertension (p<0.0005). Clinicians and normotensive individuals tend to overemphasize the impact that hypertension has on quality of life, as compared to affected patients. The relatively low impact that hypertensive individuals indicate high blood pressure has on their quality of life may contribute to their lack of compliance with treatment regimens.
63 citations
TL;DR: Ocular utility values related to the visual loss do not appear to be affected by the presence of select, concomitant, serious systemic diseases, and visual loss seems to cause a similar diminution in self assessed quality of life in those who do and do not have serious associated systemic comorbidities.
Abstract: Aim: To ascertain the effect of serious systemic comorbidities upon the quality of life of patients with ophthalmic diseases. Methods: Time tradeoff utility values were obtained in consecutive ophthalmic patients who presented with ocular disease. Multivariate analysis was undertaken to evaluate whether the systemic comorbidities of diabetes mellitus, heart disease, cancer, cerebrovascular accident, and/or renal failure requiring dialysis influenced ocular utility values. Results: Among the 390 patients with ocular diseases studied, 250 had the systemic comorbidities of diabetes mellitus, heart disease, cancer, stroke, and/or renal failure requiring dialysis, while 140 lacked these comorbidities. There was no statistically significant difference (p = 0.091) between the comorbidity and no comorbidity groups in self assessed quality of life as measured by ocular utility values after taking into account potentially confounding variables. Conclusions: In patients with ocular disease, ocular utility values related to the visual loss do not appear to be affected by the presence of select, concomitant, serious systemic diseases. Thus, visual loss seems to cause a similar diminution in self assessed quality of life in those who do and do not have serious associated systemic comorbidities. This information has important implications for the calculation of cost effective analyses.
49 citations
Journal Article•
TL;DR: Clinicians tended to overemphasize the impact that diabetes mellitus has on health related quality of life, while the non-diabetic publics' utility values are more closely correlated with those of diabetics themselves.
Abstract: Background A study was undertaken to assess the quality of life of patients with type 1 and type 2 diabetes mellitus and to ascertain whether clinicians and non-diabetic respondents from the general public have similar views of the impact of diabetes upon health-related quality of life. Material/methods Time tradeoff utility values were generated from a standardized time-tradeoff questionnaire. Three hundred and fifty-two individuals with type 1 or type 2 diabetes mellitus, 157 non-diabetic participants from the general public (community), and 61 health care clinicians participated in the study. Results The mean utility score for diabetic patients was 0.889 and the median utility score was 1.000. The mean utility score for clinicians was 0.861, with a median value of 0.894, while the respective mean and median scores for the general public were 0.919 and 0.953. There was a significant difference between the distribution of the means of scores of clinicians and patients as well as between clinicians and the general public. There was no significant difference between the utility scores of patients and the general public. Within the group of diabetic patients, there was no significant difference in utility scores between type 1 and type 2 diabetics. Conclusions Clinicians tended to overemphasize the impact that diabetes mellitus has on health related quality of life, while the non-diabetic publics' utility values are more closely correlated with those of diabetics themselves. We conclude that there is a significant difference in how clinicians, diabetics and the general public perceive the effect diabetes has upon quality of life.
38 citations
TL;DR: Laser therapy appears to be a cost-effective intervention for improving visual loss associated with macular edema secondary to branch retinal vein occlusion.
Abstract: purpose To ascertain the incremental cost-effectiveness of therapeutic interventions for improving visual loss associated with branch retinal vein occlusion. methods A cost-utility analysis incorporating data from the Branch Vein Occlusion Study Group was performed using patient-based preferences obtained from time tradeoff utility analysis, decision analysis with Markov modeling, and economic modeling with future value analysis. The cost-effectiveness results are expressed in $/QALY (dollars expended per quality-adjusted life-year) gained. This unique model takes into account the visual acuity in the better seeing eye and the recurrent risk for visual loss in the contralateral eye. results Laser therapy for macular edema secondary to branch retinal vein occlusion was associated with an incremental $/QALY gained of $6118 (in year 2000 U.S. dollars). Two-way sensitivity analysis, varying the discount rate and the proportion of patients developing a vascular occlusion in the contralateral eye, revealed a ra...
28 citations
TL;DR: A methodology by which they evaluate the visual health state of patients with severe corneal disease requiring transplantation surgery is described, finding that patients who had a high preoperative priority score, as measured by the three above criteria, were more likely to have a good outcome.
Abstract: Value based ophthalmology
In their article in this issue of the BJO (p 57) Saunders and colleagues describe a methodology by which they evaluate the visual health state of patients with severe corneal disease requiring transplantation surgery. Rather than dealing with visual acuity as the only preoperative and outcome parameters, they evaluate patients according to three criteria: (1) visual acuity, (2) ocular pain, and (3) visual function. Concerning the latter criterion, visual function, they utilise a tool called the VFA (visual function assessment),1 which they have previously described; it is essentially a modification of the VF-142 and predominantly measures ocular function characterised by the ability to perform tasks such as driving, reading, cooking, etc. They found that patients who had a high preoperative priority score, as measured by the three above criteria, were more likely to have a good outcome. One measure in the study that is somewhat unclear, though, is how the results incorporate vision in the eye that did not receive a transplant. All too often our clinical trials and other studies fail to address the status of the second eye, perhaps a factor more important to the patient that the ocular intervention itself. The authors noted that 72.4% of patients demonstrated an improved VFA after transplant, but it is uncertain whether this was measured using only the operated eye or in a real world situation in which both eyes were used during the assessment.
The authors should be congratulated upon bringing more than visual acuity alone into the decision making process. Most ophthalmologists believe …
19 citations
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