Abstract
Purpose :
Low vision aids (LVAs), such as optical magnifiers, can improve performance of everyday tasks for individuals with visual impairment. With the introduction of p-EVES (portable handheld electronic LVAs), the question arises whether these offer real benefits to users, compared to simple LVAs. This prospective two-arm cross-over randomised controlled trial aimed to determine the clinical effectiveness, acceptability, and incremental cost-effectiveness of p-EVES compared to optical LVAs.
Methods :
Experienced optical aid users (n=100) were recruited from Manchester Royal Eye Hospital, UK. Reading, performance of near vision activities, and device usage, were evaluated at baseline; and at 2 and 4 months, at the end of each study arm (A: existing optical aids plus p-EVES; B: optical aids only). Incremental cost-effectiveness ratios (ICERs) and cost-utility analyses were based on health- and vision-related QoL questionnaires using bootstrapping techniques. Economic evaluation was undertaken from a societal perspective, and included carer time costs.
Results :
Overall, maximum reading speed for high contrast sentences was the same for optical aids and p-EVES, although the critical and threshold print sizes accessed with p-EVES were both significantly smaller (p<0.001). Optical aids were used for more tasks (p<0.001), and more frequently (p<0.001). However 70% preferred p-EVES for leisure reading, and p-EVES gave longer duration of reading (p<0.001). During the study arm with p-EVES, participants carried out more tasks independently (p<0.001), and reported less difficulty with near vision activities (p<0.001). An ICER of £735.77 (95% confidence interval = £481.03 - £1525.18) was found for a 6.73% improvement in ‘near vision’ visual function. Cost per QALY was estimated between £56,991.43 (lower 95% CI = £19,801.27) and £66,490.00 (lower 95% CI = £23,054.59). Sensitivity analysis reduced ICERs by up to 75%, with QALYs falling below £30,000.
Conclusions :
The p-EVES tested did not replace optical aids, but were more effective for certain tasks. p-EVES are likely to be a cost-effective way to improve visual function at near, but this does not translate into improved quality of life, wellbeing and capability. However, sensitivity analysis indicated that cost-effectiveness may be achievable with a lower cost intervention.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.