Results of the basic-VRS trial: clinical outcomes and cost-effectiveness of basic low vision rehabilitation in Portugal

Abstract Purpose The aim of this study was twofold: i) to investigate and characterize the clinical impact of vision rehabilitation in patients with vision impairment, and ii) to investigate the cost-effectiveness of a basic vision rehabilitation service in Portugal. Methods Patients diagnosed with age-related macular degeneration or diabetic retinopathy and visual acuity in the range 0.4 to 1.0 logMAR in the better-seeing eye were recruited. Participants were randomised to one of the study arms consisting of immediate intervention and delayed intervention. The intervention included: new refractive correction, optical reading aids, in-office training and advice about modifications at home. Visual ability, health-related quality-of-life and costs of the intervention were measured. Economic analysis was performed to evaluated if the intervention was cost-effective. The trial compared the outcomes 12-weeks after the start in both arms. Results Of the 46 participants, 34(74%) were diagnosed with diabetic retinopathy, 25(54%) were female and the mean age was 70.08 yrs (SD=8.74). In the immediate intervention arm visual ability was 0.28 logits (SD=1.14) at baseline and it increased to 0.91logits (SD=1.24) after the intervention (p<0.001). Changes in the delayed intervention arm were not statistically significant (mean improvement = 0.10 logits, SE=0.11, p=0.95). Acuity in the better seeing eye, near acuity and critical print size also improved during the study. The mean cost of the intervention was €118.79 (SD=24.37). Incremental cost-effectiveness ratio using the EQ-5D-5L index value was €3322/QALY and €1235/QALY when using near acuity. Conclusions The current study gives evidence of positive clinical impact of a basic vision rehabilitation intervention and that a basic vision rehabilitation service is cost-effective. These findings are important to clinical and rehabilitation practices and for planning vision rehabilitation services.