Dollars and Sense


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Economic impact of Eye Care

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Dollars and Sense

  1. 1. Eye Care: Dollars and Sense Taylor HR. Am J Ophthalmol 2007; 143:1-8. Journal Club Terry J. Alexandrou, MD Department of Ophthalmology and Visual Science University of Chicago
  2. 2. Purpose <ul><li>Develop a model of the economic impact of vision loss in Australia </li></ul>
  3. 3. Design <ul><li>Data obtained from: </li></ul><ul><ul><li>Population based epidemiologic studies of eye disease </li></ul></ul><ul><ul><li>Studies of the impact of vision loss on daily living </li></ul></ul><ul><ul><li>Australian national health-care costs </li></ul></ul><ul><ul><li>Census </li></ul></ul><ul><ul><li>Demographic projections </li></ul></ul><ul><li>Data used to assess the current magnitude and costs of vision loss and to make projections as to future costs </li></ul>
  4. 4. Population Based Evidence <ul><li>Melbourne Visual Impairment Project (VIP) </li></ul><ul><ul><li>Large, population based survey </li></ul></ul><ul><ul><li>Purpose: </li></ul></ul><ul><ul><ul><li>Determine the prevalence and causes of vision loss </li></ul></ul></ul><ul><ul><ul><li>Examine the risk factors for vision loss </li></ul></ul></ul><ul><ul><ul><li>Identify barriers to the provision of eye care </li></ul></ul></ul><ul><ul><li>5 years to complete survey </li></ul></ul><ul><ul><li>Included urban, rural, and institutionalized populations rather than those from a single geographic location </li></ul></ul><ul><ul><li>Minorities represented in similar proportions to national average </li></ul></ul><ul><ul><li>Similar to other large pop studies (Beaver Dam, ect.), however did not exclude based on age </li></ul></ul>
  5. 5. Prevalence and Causes of Vision Loss Amount of vision loss and eye disease increases dramatically with increasing age (2004)
  6. 6. Prevalence and Causes of Vision Loss Prevalence of blindness (≤20/200 in better eye) Prevalence of low vision (<20/40 in better eye)
  7. 7. Prevalence and Causes of Vision Loss (US in 1909) Ophthalmia neonatum and injury were leading causes of blindness 100 years ago, when life expectancy was ~40 years
  8. 8. Prevalence and Causes of Vision Loss Australia in 2004 Age > 40 Causes of blindness (≤20/200) Causes of visual impairment (<20/40)
  9. 9. Impact of Vision Loss <ul><li>Critical level of vision is that level usually required for an unrestricted drivers license </li></ul><ul><li>People with VA < 20/40 have sig. increased risk of: </li></ul><ul><ul><li>Falls 28,29 </li></ul></ul><ul><ul><li>Hip fractures 30,31 </li></ul></ul><ul><ul><li>Depression 32,33 </li></ul></ul><ul><ul><li>Loss of social independence 34,35 </li></ul></ul><ul><ul><li>Likely to be admitted to nursing homes 3 years earlier than those with normal vision 36 </li></ul></ul>
  10. 10. Costs of Vision Loss Australia Vision loss is the 7 th leading cause of disability in Australia Causes nearly 3% of the national total of years of life lost attributable to disability
  11. 11. Costs of Vision Loss (2006) Vision loss ranks as the 6 th most important cause of disability worldwide
  12. 12. Costs of Vision Loss Australia(2004) Total cost of vision loss was ~10 billion Indirect costs - ~3.2 billion ● loss of earnings ● cost of caregivers ● additional age care Loss of well-being - ~4.8 billion Lost income - ~1.8 billion Direct costs - ~1.9 billion ● hospital care ● outpatient and office visits ● optometry costs ● medications
  13. 13. Costs of Vision Loss Direct Health Costs for vision disorders ranks 7 th in Australian rankings Cataract surgery is the single largest condition cost 180,000 cataract surgeries performed in Australia in 2005
  14. 14. Costs of Eye Care <ul><li>WHO considers intervention to be cost-effective if it costs less than 3x GDP per capita to avert 1 lost quality adjusted life year (QALY) </li></ul><ul><ul><li>In Australia - < $112,000 per QALY </li></ul></ul><ul><li>Very cost effective : < 1 GDP per capita </li></ul><ul><ul><li>In Australia - < $37,000 per QALY </li></ul></ul><ul><li>Cataract surgery : < $3,000 per QALY </li></ul><ul><li>Diabetic Retinopathy Screening: < $20,000 per QALY </li></ul>
  15. 15. Costs of Vision Loss <ul><li>Authors propose 3 measures to reverse the projected increase in the prevalence, economic costs, and loss of well-being associated with vision loss </li></ul><ul><li>1) Prevention </li></ul><ul><li>2) Provide adequate funding for eye care services for treatable eye conditions </li></ul><ul><li>3) Substantial increase in funding for targeted research into </li></ul>
  16. 16. Costs of Vision Loss Australia could save 5 dollars for each dollar spent
  17. 17. Discussion <ul><li>This data on the health economic impact of vision loss will be useful in helping to argue the importance of eye care to policy-makers </li></ul><ul><li>Provides data required to place the needs for eye care in perspective and to compare it with other health priorities </li></ul><ul><li>This data is specific for Australia, but may provide some information into the situations in the U.S and other developed countries </li></ul>
  18. 18. Discussion <ul><li>The Australian government committed 14 million to eye health promotion in the May 2006 budget </li></ul>