Starting with the January issue, this journal will have a new name. Evidence-Based Eye Care will proudly become Evidence-Based Ophthalmology. The editors have made this decision after examining our core constituency, the ophthalmologist community. We are most pleased that both ophthalmologists in the academic arena and the private practice clinician arena alike find the journal both informative and useful. We are confident that the journal will continue to appeal to all who are involved with care of the visual system.
First, let us thank all of the talented reviewers on the Editorial Board who have provided superb reviews that greatly enhance the value of the journal. While most peer-reviewed medical journals do not have experts comment on the articles contained therein, the expert critique remains a central part of our journal. We believe that the insight of talented practitioners commenting on articles within their area(s) of expertise gives the reader an insight into clinical usefulness that is often not otherwise clear or apparent.
The articles selected for review are those that we believe best demonstrate the finest evidence-based principles in the recently published literature. Even these are critiqued by our reviewers, often with the result of enhancing the overall value of the article to the reader. One thing that we know is that if the reviewers also agree that the articles are good, they are publications that the readership should keep in their disease-fighting armamentarium.
Since the journal was initiated in 1999, value-based medicine has become a term more familiar to many physicians. With the advent of the Medicare Prescription Drug, Improvement and Modernization Act of 2003,1 the terms used in Evidence-Based Ophthalmology will become even more familiar to the readership. Why? Because the bill mandates a $50 million expenditure for the study of the cost-effectiveness of pharmaceuticals. While the exact method of analysis is not specified, there is every reason to believe that it will take the form of cost-utility analysis. Thus, we firmly believe value-based medicine and cost utility should and will become integral parts of the health care equation within the decade.
Over the past two decades, reimbursement for ophthalmologic interventions has dramatically decreased. In the early 1980s, the Medicare reimbursement for cataract removal and intraocular lens implantation was in the range of $2000, while the national average in 2004 is $684.2 Thus, in 2004, reimbursement for cataract surgery, adjusted for inflation,3 is 17% of what is was in the early 1980s.
Cost-utility analysis, the form of health care economic analysis that provides the information necessary to create value-based medicine standards, has been performed for the intervention of cataract surgery with intraocular lens implantation. For cataract surgery in the first eye, the cost utility is $2182/QALY4 (quality-adjusted life-year) in 2004 dollars, while that for the second eye is $2890/QALY5 in 2004 dollars. Cataract surgery in the second eye is similar to the first eye in conferred value and cost-effectiveness because people with one eye generally have considerable worry about the fate of that eye. Having two eyes with good vision confers peace of mind and thus is associated with better quality of life than having good vision in one eye.6This is an important concept that applies to other ocular interventions as well as to people with only one good organ in what is normally a two-organ system (ears, lungs, kidneys).
Considering that the most common upper limit of cost-effectiveness for cost-utility analysis is $100,000,7 cataract surgery in both the first eye and the second eye delivers among the greatest value of the common major interventions in health care. Additionally, this surgery is among the most cost-effective, common, major interventions in health care. Had this information been available 20 years earlier, it is likely that the current Medicare reimbursement for cataract surgery would not have experienced such a draconian cut, especially considering the great value that cataract surgery in either eye confers to the average patient.
Looking to the future, the superior value and great cost-effectiveness of cataract surgery in the second eye will be powerful deterrents to those who might say second-eye surgery is not of sufficient benefit to merit reimbursement. This applies to other ophthalmic interventions as well, which as a group remain among the most cost-effective in medicine.8
In the journal, we will attempt to continue to highlight relevant articles that represent the best of evidence-based medicine. In this regard, we attempt to choose articles that are relevant to the practicing clinician. At times, the balance is difficult since articles that demonstrate good evidence-based principles may have nominal clinical importance. On occasion, we will include nonophthalmologic evidence-based studies that we believe provide basic knowledge relevant and important to all who practice medicine.
We thank the readership for support of the journal and welcome suggestions for improvement at any time to Editors, Evidence-Based Ophthalmology, Center for Value-Based Medicine, 1107 Bethlehem Pike, Suite 210, Flourtown, PA 19031. We hope that you have as much enjoyment reading the journal as we have in working with our talented colleagues in editing it.
1. Medicare Modernization Update, Centers for Medicare and Medicaid Services, Washington, DC. Available at http://www.cms.hhs.gov/mmu/default.asp
(accessed 10 October, 2004).
2. American Academy of Ophthalmology. Proposed Medicare Fee Schedule Includes Provisions Fought by the Academy. Available at www.AAO/AAO2005/payments.html
(accessed 10 October, 2004).
3. U.S. Department of Labor Bureau of Labor and Statistics. Overview of BLS Statistics on Inflation and Consumer Spending. Available at http://www.bls.gov/bls/inflation.htm
(accessed 10 October, 2004).
4. Busbee B, Brown MM, Brown GC, et al. Incremental cost-effectiveness of initial cataract surgery. Ophthalmology
5. Busbee B, Brown MM, Brown GC, et al. A cost-utility analysis of cataract surgery in the second eye. Ophthalmology
6. Brown MM, Brown GC, Sharma S, et al. Quality- of-life associated with unilateral and bilateral good vision. Ophthalmology
7. Brown MM, Brown GC, Sharma S. Evidence-Based Medicine to Value-Based Medicine
. Chicago: AMA Press (in press).
8. Brown GC, Brown MM, Sharma S. Value-based medicine: evidence-based medicine and beyond. Ocul Immunol Inflamm