PURPOSE:The Department of Veterans Affairs (VA) Low Vision Intervention Trial (LOVIT) developed an outpatient low-vision programme for patients with macular diseases providing low-vision rehabilitation comparable to VA inpatient blind rehabilitation centres (BRCs). This programme targets veterans who do not need or chose not to participate in a comprehensive inpatient blind rehabilitation programme. We examined costs and consequences using veterans in LOVIT and comparable veterans in an inpatient BRC. METHODS:We compared costs and consequences between treatment patients who participated in LOVIT, a two-site randomized clinical trial, and a sample of comparable patients who received treatment at a VA inpatient BRC. We measured consequences as the change in functional visual ability from baseline to follow-up (LOVIT: 4 months after randomization; BRC: 3 months after discharge) using the VA Low Vision Visual Functioning Questionnaire (VA LV VFQ-48). RESULTS:There were 55 LOVIT and 121 BRC patients for our analyses. Average costs were $38,627.3 higher for BRC patients ($5,054.4 +/- $404.7 SD for LOVIT vs. $43,681.7 +/- $8,853.6 SD for BRC, p < 0.0001). Thus, the BRC cost $38,627.3 per patient more than the LOVIT programme (95% CI: $17,414 to $273,482). There was a greater improvement in overall visual ability, mobility, and visual motor skill scores for BRC patients; however, there was no significant difference in improvement in reading ability or visual information processing scores. CONCLUSIONS:As VA increases outpatient blind rehabilitation services, LOVIT provides a model for expanding outpatient low-vision rehabilitation services for veterans at substantially lower costs than current inpatient BRC services.

译文

目的:退伍军人事务部(VA)低视力干预试验(LOVIT)为黄斑疾病患者制定了门诊低视力计划,该计划可提供与VA住院盲人康复中心(BRC)相当的低视力康复服务。该计划针对不需要或选择不参加全面的住院盲人康复计划的退伍军人。我们使用LOVIT中的退伍军人和住院BRC中可比的退伍军人检查了成本和后果。
方法:我们比较了参加LOVIT的治疗患者,一项两点随机临床试验和在VA住院BRC接受治疗的可比较患者的样本之间的成本和后果。我们使用VA低视力视觉功能问卷(VA LV VFQ-48),测量了从基线到随访(LOVIT:随机分组后4个月; BRC:出院后3个月)的功能性视觉能力变化的后果。
结果:本研究共纳入55例LOVIT患者和121例BRC患者。 BRC患者的平均费用高出38,627.3美元(LOVIT为$ 5,054.4 /-$ 404.7 SD,而BRC为$ 43,681.7 /-$ 8,853.6 SD,p <0.0001)。因此,每位患者的BRC费用比LOVIT计划高出38,627.3美元(95%CI:17,414美元至273,482美元)。 BRC患者的整体视觉能力,活动能力和视觉运动技能得分有了更大的提高;但是,阅读能力或视觉信息处理得分的提高没有显着差异。
结论:随着VA增加门诊盲人康复服务,LOVIT提供了一种模式,可为退伍军人扩展门诊低视力康复服务,其成本远低于目前的住院BRC服务。

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