Evaluating the Cost-effectiveness of Realistic Screening Interventions Across Sev

描述（由申请人提供）：评估眼科筛查举措的成本效益可以指导决定何时何地实施筛查。如果做得好，这些分析可以帮助定位稀缺的视觉健康资源，以合理的成本最大化社会福祉。随着美国人口的老龄化，由于主要成人视力障碍的流行病学与年龄有关，因此在美国，有针对性的视力健康筛查的需求正在增加。然而，评估目视筛查的成本效益是复杂的，因为在常规使用目视筛查服务的亚人群差异。未能考虑到这种异质性的模型可能会导致关于筛查服务在何时何地合理的错误结论。在该项目的目标1中，我们将对现有的视觉健康模拟模型进行实质性改进，使其能够根据比弗坝眼科研究和洛杉矶拉丁裔眼科研究中经验观察到的患者数据来解释异质患者筛查史。该模型至少在三个重要方面是独一无二的：(1)它将是唯一的成本效益模型，包括通过单一筛查干预预防多种眼病的好处；(2)它将是唯一一个评估在现实的混合年龄组人群中实施的视觉健康筛查干预的成本效益的视觉健康筛查模型；(3)它将是唯一一个在个体水平上包含真实患者数据的视觉健康模型，这使得该模型能够模拟在异质患者混合组中进行筛查的益处。在目标2中，我们将使用改进的模型来估计视力健康筛查干预措施的成本效益，同时考虑到预防多种眼病的好处，并考虑到患者在过去服务使用、保险覆盖范围和筛查成本方面的差异。最后，在目标3中，我们将使用成本效益分析的结果来开发一个用户友好的软件工具，使研究结果能够以一种对他们个人环境最有意义的方式传播给广泛的决策者、从业者和研究人员。如果项目成功，整体而言可改善视力健康检查服务的目标，并以合理的成本改善公共福利。

DESCRIPTION (provided by applicant): Evaluating the cost-effectiveness of ophthalmologic screening initiatives can guide decisions about when and where to implement screening. If done well, these analyses can help target scarce visual health resources in a way that maximizes societal well-being at a reasonable cost. The need for targeted visual health screening in the United States is increasing as the U.S. population ages because the epidemiology of major adult visual disorders is age-related. However, assessing the cost-effectiveness of visual screening is complicated by subpopulation differences in the routine use of visual screening services. Models that fail to account for this heterogeneity may lead to erroneous conclusions about where and when screening services are justified. In Aim 1 of this project, we will make substantial improvements to an existing visual health simulation model that will enable it to account for heterogeneous patient screening histories based on empirically observed patient data from the Beaver Dam Eye Study and the Los Angeles Latino Eye Study. The model will be unique in at least three important respects: (1) it will be the only cost-effectiveness model that includes the benefits of preventing multiple eye diseases with a single screening intervention; (2) it will be the only visual health screening model that evaluates the cost-effectiveness of a visual health screening intervention implemented in a realistic, mixed-age group population; and (3) it will be the only visual health model that incorporates real patient data at the individual level, which enables the model to simulate the benefit of screening among a mixed group of heterogeneous patients. In Aim 2, we will use the improved model to estimate the cost-effectiveness of visual health screening interventions when considering the benefits of preventing multiple eye diseases and accounting for patient differences in past service use, insurance coverage, and costs to screen. Finally, in Aim 3, we will use the results from our cost-effectiveness analyses to develop a user-friendly software tool that will enable findings to be disseminated to a wide range of decision makers, practitioners, and researchers in a way that is most meaningful in their individual setting. If successful, the project as a whole could lead to improvements in the targeting of visual health screening services and enhancements to the public welfare at a reasonable cost.