The phrase quality-adjusted life year (QALY) is something only a statistician could love. It may not be the most accessible concept, but it’s a vital part of the equation in how health interventions are measured and policy is made. The goal is to work out the cost/benefit ratio of medical interventions by comparing their price tag against the impact on both the quality of life and duration of effect on the individual. Efforts that improve the lives of children usually do well in such an analysis because of the potential for lifelong improvement; the same isn’t always true in older patients.
In one report, universal eye exams for kids come in at $18,930 QALY and (in a separate, older study) ambylopia treatment specifically is priced at just $2,281 QALY. By contrast, liver transplant has been pegged at $350,000 QALY, given its phenomenal cost and the low life expectancy of the patient.
Children’s health should be taken care of as a moral value regardless of cost. But when the interventions are also a bargain—as most routine eye care is—it’s a no-brainer. So, it’s all the more distressing that this great opportunity is being missed for many kids in need.
“Our nation’s historical misreliance on vision screening has plagued our education, mental health and juvenile justice systems for too long, serving as major contributive factors to children’s inability to perform and conform to the demands of school and society,” says the AOA in a recent statement.
Vision screening (vs. a full exam), “by falsely telling too many children that they have no vision problem, when they actually do, has long closed the door to vision health and education opportunities,” says the AOA, noting that screenings have a sensitivity of just 27%.
The Affordable Care Act made preventive care a priority, and pediatric vision is a part of its essential health benefit. But one small study, presented at the recent Academy of Optometry meeting, found that only 56% of optometry practices have seen ACA patients. ODs in solo optometric practice had the lowest participation rate (45.5%) and those in group OD/MD practice had the greatest (61%).
We’re focusing on pediatric eye care in this month’s 20th annual comanagement report to help bring attention to these matters.“Optometrists will have the chance to make history because of the profession’s unique position to provide greatly needed services,” says Kathleen Foster Elliott, OD, in her article on the ACA and pediatric eye care, which opens our series this month (see "ACA Children’s Vision Health Benefit: Boom or Bust?"). In her article and the ones to follow, experts give concrete advice on how to make routine pediatric eye care an essential part of your practice. It’ll take outreach to community leaders, pediatricians and local ophthalmologists, but the need is too great to ignore. Only 14% of all children have had an eye exam by age six, and 10 million have undetected vision problems. A little extra effort could make a tremendous difference.