Orthoptist and health economist Matthew McCarthy explains why economic evaluation matters for the
future of eyecare.
As demand for public eyecare services continues to surge across Australia1, the question facing many public ophthalmology departments isn’t just how to keep up – it’s how to do it sustainably. With one in ten ophthalmologists working in public hospitals2 , growing patient waiting lists, and rising healthcare costs have pushed services to rethink long standing models of care.
One tool is proving particularly powerful in guiding that rethink: economic evaluation.
Economic evaluations are more than a costing exercise. An economic evaluation asks a deceptively simple question: What model of care delivers the best value for the resources invested?
Economic evaluations do this by comparing inputs (staffing, time, equipment, training), outputs (patient outcomes, throughput, safety, access) and value (whether the benefits justify the costs)3.
Often misunderstood as a purely academic exercise, economic evaluation is increasingly shaping real world decisions about workforce redesign, advanced practice roles, and service efficiency.
In allied health, physiotherapy has led the way. Advanced practice physiotherapy models across multiple diverse clinical settings have repeatedly been found to be cost-effective, with substantial potential cost savings4. However, in ophthalmology, including orthoptics, economic evaluations remain surprisingly scarce.
That gap is beginning to close. What started as a master’s economic research project at a Victorian acute ophthalmology service, has demonstrated just how transformative Advanced Practice Orthoptists (APOs) can be for sustaining public eyecare services5.
My research study involved an economic evaluation comparing two parallel models of care: the Advanced Practice Orthoptist (APO) model and the Doctor in Training (DiT) model in an acute ophthalmology setting. Because the clinical outcomes and patient flow were found to be equivalent, the study used a cost minimisation framework, allowing a clear focus on labour costs; the largest driver of expenditure in acute ophthalmic care.
The results were hard to ignore. Clinical outcomes were equivalent, with no adverse events, accurate diagnosis, and appropriate management across both models under consultant oversight. Patient throughput was maintained, demonstrating no compromise to efficiency, and labour cost savings were substantial, driven by lower hourly rates in the APO model.
Beyond the cost savings, the research study investigated the robustness of the APO model; a critical factor for any workforce redesign. Several features contributed to this robustness. These include strong governance and supervision structures, reproducibility across consultant staffing scenarios, and workforce stability.
Strong governance and supervision structures enabled APOs to operate within established consultant oversight frameworks allowing clinical safety while enabling autonomous decision making.
Sensitivity analyses demonstrated that the APO model remained cost-advantageous even when consultant seniority and supervision time were varied. This suggests the model is resilient to real-world staffing fluctuations.
Unlike DiTs, who rotate frequently, APOs provide continuity, reducing onboarding time (and costs) while preserving institutional knowledge; a key contributor to service reliability.
Why does this matter?
The implications extend far beyond a single service. Advanced practice roles can help reduce bottlenecks in acute and routine care, improve access for high volume conditions, strengthen workforce sustainability, and free medical staff for more complex or surgical cases, without compromising on patient outcomes – and all delivered at a lower cost.
For health service executives and clinical directors, this kind of evidence is compelling. It shifts the conversation from “Is this safe?” to “Why aren’t we scaling this?”
Evidence driven change
Despite their value, economic evaluations remain underused in allied health and ophthalmology. Many innovative models are implemented without robust assessment of their cost effectiveness, making it harder to secure long term funding or scale successful pilots.
The APO vs DiT evaluation demonstrates what happens when economic thinking is embedded into service redesign: Workforce innovation becomes measurable, funding decisions become defensible while advanced practice roles gain legitimacy and health services can redesign care with confidence.
The takeaway
As demand continues to rise, the sector needs more than goodwill and incremental change. It needs evidence backed redesign. Economic evaluation provides that foundation.
The APO model shows that when orthoptists work to the top of their scope, the entire system benefits: patients, clinicians, and budgets alike.
The challenge now is to ensure economic evaluation becomes standard practice in workforce planning, not an optional extra – because in a resource constrained system, the real question isn’t “Can we afford to evaluate?” It’s, “Can we afford not to?”
About the author: Matthew McCarthy is a senior orthoptist at Gold Coast Hospital and Health Service, and an honorary researcher at the Royal Victorian Eye and Ear Hospital. He has a Master’s degree in health economics.
References
1.Department of Health (2018) Australia’s Future Health Workforce–Ophthalmology. Available at: https://www.health.gov. au/resources/publications/ophthalmology-australias-future-health-workforce-report (Accessed: 4 August 2025)
2. (2025) ‘Ophthalmology Workforce Crises Debated’, MIVISION the ophthalmic journal. 30 May. Available at: https://mivision.com.au/2025/06/ophthalmology-workforce-crisis-debated/ [Accessed 11 Apr. 2026].
3. Drummond, M., Sculpher, M., Claxton, K., Stoddart, G., & Torrance, G. (2015). Methods for the economic evaluation of health care programmes. 4th ed. Oxford: Oxford University Press.
4. Lafrance, S., Demont, A., Thavorn, K., Fernandes, J., Santaguida, C., & Desmeules, F. (2021) ‘Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses’, BMC Health Services Research, 21(1). Available at: https://doi: 10.1186/s12913-021-07221-6
5. Mancuso C. Orthoptics expands scope of practice. Mitchell R, editor. Insight. 2026 May;51.
