Gary C. Brown

The financial desirability of dollar/time investments in postbaccalaureate healthcare professional education is needed. We therefore compared postbaccalaureate educational costs and career earnings for nurse anesthetists, eight other advanced degree, nonphysician professions, and 14 physician specialties with internal rate of return (IRR) and net present value (NPV) analysis. The IRR and NPV integrated educational costs (tuition, finance charges, lost salary opportunity costs), and career earnings using U.S. Bureau of Labor and Medscape 2022 Physician Compensation Report data. Costs were discounted to 2022 U.S. real dollars using the 3.97% 50-year, U.S. average inflation rate. Annual IRRs for educational investment were 1) hospital CEOs = 48.8%; 2) managed care finance directors = 48.2%; 3) Doctors of Nurse Anesthesia Practice = 26.0%; 4) specialist physicians = 20.3%; 5) primary care physicians = 19.2%; 6) Doctors of Physical Therapy = 18.8%; 7) healthcare attorneys = 18.4%; 8) Doctors of Dental Surgery (dentists) = 18.1%; 9) Doctors of Pharmacy = 17.2%; and 10) Advanced Nurse Practitioners = 10.8%. Considering the educational money/time invested for career monetary returns, the financial desirability of nurse anesthetist and nonphysician, healthcare executive education exceeded that of physicians. Lifetime earnings for nurse anesthetists exceeded those of Doctors of Dental Surgery (Doctors of Dental Medicine), Doctors of Pharmacy, Doctors of Physical Therapy, managed care MBAs, biomedical engineers, healthcare attorneys, and Advanced Nurse Practitioners.

Introduction Oral administration of zeaxanthin (Zx) 20 mg daily in patients with unilateral neovascular age-related macular degeneration (nAMD) treated with triple therapy (photodynamic therapy/intravitreal bevacizumab/intravitreal dexamethasone) reduced fellow-eye 2-year nAMD incidence from 23 to 6% (p = 0.02) in a prior clinical trial. We questioned the long-term benefit and thus analyzed case–control 5-year patient data of trial participants and additional participants with 5-year follow-up, also performing cost-utility and cost–benefit analyses. Methods Consecutive, unilateral nAMD patient outcomes for those taking 20 mg Zx supplementation orally for ≥ 5 years were compared with the Comparison of AMD Treatments Trials (CATT) 5-year historical controls for fellow-eye nAMD conversion. Eleven-year mean life expectancy, cost-utility and cost–benefit models were undertaken employing a 3% discount rate and 2020 US real dollars. Results Among 227 consecutive patients with nAMD/Zx-supplementation, 202 (90%) had 5-year follow-up. The fellow-eye nAMD 5-year conversion incidence using a Kaplan–Meier cumulative event estimate was 22% (49/227), versus 48% (167/348) with CATT control data (p < 0.0001). An 11-year cost-utility model with estimates for years 6–11 demonstrated a 0.42 (7.7%) QALY (quality-adjusted life-year) gain, including 3 months of life saved per patient due to decreased nAMD fellow-eye conversion. This yielded a direct ophthalmic medical cost perspective, incremental cost-utility ratio (CUR) of −$576/QALY and a societal cost perspective CUR of −$125,071/QALY. Zx supplementation for all 2020 US unilateral nAMD cases would have theoretically saved society, primarily patients, $6.0 billion over 11 years, a 1531% return on investment (ROI), or 31.3% annual ROI, on Zx costs. Conclusions Oral zeaxanthin supplementation for unilateral nAMD patients appears to decrease fellow-eye long-term incidence and is cost-effective and financially rewarding. It is dominant vs. no supplementation in patients presenting with unilateral nAMD. Trial Registration ClinicalTrials.gov identifier, NCT01527435.

Cost-utility analysis (incremental cost-effectiveness analysis) evaluates health care interventions by integrating objective improvement in patient quality of life (QOL) and/or length of life with costs using the cost-utility ratio of dollars expended per quality-adjusted life-year (QALY) gained.¹ Quality of life is quantified by utilities.²