Economics of high-frequency home monitoring versus clinic-based perimetry

This audio article is from VisualFieldTest.com.Read the full article here: https://visualfieldtest.com/en/economics-of-high-frequency-home-monitoring-versus-clinic-based-perimetryTest your visual field online: https://visualfieldtest.comSupport the show so new episodes keep coming: https://www.buzzsprout.com/2563091/supportExcerpt:Economics of High-Frequency Home Monitoring vs Clinic-Based Perimetry Glaucoma is a chronic eye condition that gradually shrinks side (peripheral) vision. It requires ongoing visual field testing (perimetry) to track disease progression and prevent vision loss. Traditionally, these tests are done in the clinic about every 6–12 months (). However, new home perimetry technologies (tablet apps or headsets) allow patients to test more often at home () (). Home testing could be much more convenient – saving travel and wait time – and might catch changes earlier. For example, in a remote-care model for glaucoma, patients saved an average of 61 travel hours compared to in-person exams (). Yet home tests also have costs (devices and data review) and performance uncertainties. Early reviews point out that while many home and portable perimeters are promising, their real-world accuracy and value still need validation (). Clinic-Based vs Home Perimetry Clinic perimetry is very reliable but requires specialized equipment (like a Humphrey Field Analyzer) and trained staff. It can be costly and burdensome – patients must take time off and possibly travel far for tests. In contrast, home monitoring offers comfort and flexibility. Patients can test on a personal tablet at home, often with simple apps that guide the procedure (). Users and eye doctors alike are optimistic: one UK study found patients and clinicians were cautiously positive about home glaucoma checks, citing potential convenience and cost-savings () (). In that study, most patients were able to use home devices regularly – 95% completed follow-up visits and 55% maintained ~80% or better adherence over 3 months (). However, home tests can be less controlled. For example, one trial of an iPad perimeter found about 44% of the unsupervised tests were flagged as unreliable (often due to distraction or fatigue), versus only 18% in the clinic (). Nevertheless, well-designed home tests have shown results closely matching clinic tests when done correctly. In fact, home testing had similar false-positive error rates to the clinic test (~14% in both cases) (). The bottom line is that home perimetry can free patients from some clinic visits (and save on travel and wait time) (), but it also depends on patient tech skills and diligence. Building Economic Models: Costs and Outcomes To compare home monitoring with clinic testing, researchers use decision-analytic models (often Markov models) that simulate patient health over many years () (). These models assign patients to vision states (no vision loss, moderate loss, severe loss) and simulate transitions between them each year. They tally up all costs (device, staff, clinic visits, treatments) and all health outcomes (measured in quality-adjusted life years or QALYs – a combination of length and quality of life). A QALY of 1 equals one year in perfect vision-health. For example, if home monitoring helps preserve vision and adds 0.1 QALY per patient (about 1.2 extra vision-quality months), and it costs an extra \$1,000 per patient, then the cost per QALY is \$10,000. Interventions below a country’s cost-effectiveness threshold (often \$50,000/QALY in the US or ~£20–30k in the UK) are generally considered good value () (). Key Factors in the Models Several real-world factors hugely affect the cost-effectiveness of home teSupport the show