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

Purpose Develop a model of the economic impact of vision loss in Australia

Develop a model of the economic impact of vision loss in Australia

Design Data obtained from: Population based epidemiologic studies of eye disease Studies of the impact of vision loss on daily living Australian national health-care costs Census Demographic projections Data used to assess the current magnitude and costs of vision loss and to make projections as to future costs

Data obtained from:

Population based epidemiologic studies of eye disease

Studies of the impact of vision loss on daily living

Australian national health-care costs

Census

Demographic projections

Data used to assess the current magnitude and costs of vision loss and to make projections as to future costs

Population Based Evidence Melbourne Visual Impairment Project (VIP) Large, population based survey Purpose: Determine the prevalence and causes of vision loss Examine the risk factors for vision loss Identify barriers to the provision of eye care 5 years to complete survey Included urban, rural, and institutionalized populations rather than those from a single geographic location Minorities represented in similar proportions to national average Similar to other large pop studies (Beaver Dam, ect.), however did not exclude based on age

Melbourne Visual Impairment Project (VIP)

Large, population based survey

Purpose:

Determine the prevalence and causes of vision loss

Examine the risk factors for vision loss

Identify barriers to the provision of eye care

5 years to complete survey

Included urban, rural, and institutionalized populations rather than those from a single geographic location

Minorities represented in similar proportions to national average

Similar to other large pop studies (Beaver Dam, ect.), however did not exclude based on age

Prevalence and Causes of Vision Loss Amount of vision loss and eye disease increases dramatically with increasing age (2004)

Prevalence and Causes of Vision Loss Prevalence of blindness (≤20/200 in better eye) Prevalence of low vision (<20/40 in better eye)

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

Prevalence and Causes of Vision Loss Australia in 2004 Age > 40 Causes of blindness (≤20/200) Causes of visual impairment (<20/40)

Impact of Vision Loss Critical level of vision is that level usually required for an unrestricted drivers license People with VA < 20/40 have sig. increased risk of: Falls 28,29 Hip fractures 30,31 Depression 32,33 Loss of social independence 34,35 Likely to be admitted to nursing homes 3 years earlier than those with normal vision 36

Critical level of vision is that level usually required for an unrestricted drivers license

People with VA < 20/40 have sig. increased risk of:

Falls 28,29

Hip fractures 30,31

Depression 32,33

Loss of social independence 34,35

Likely to be admitted to nursing homes 3 years earlier than those with normal vision 36

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

Costs of Vision Loss (2006) Vision loss ranks as the 6 th most important cause of disability worldwide

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

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

Costs of Eye Care 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) In Australia - < $112,000 per QALY Very cost effective : < 1 GDP per capita In Australia - < $37,000 per QALY Cataract surgery : < $3,000 per QALY Diabetic Retinopathy Screening: < $20,000 per QALY

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)

In Australia - < $112,000 per QALY

Very cost effective : < 1 GDP per capita

In Australia - < $37,000 per QALY

Cataract surgery : < $3,000 per QALY

Diabetic Retinopathy Screening: < $20,000 per QALY

Costs of Vision Loss Authors propose 3 measures to reverse the projected increase in the prevalence, economic costs, and loss of well-being associated with vision loss 1) Prevention 2) Provide adequate funding for eye care services for treatable eye conditions 3) Substantial increase in funding for targeted research into

Authors propose 3 measures to reverse the projected increase in the prevalence, economic costs, and loss of well-being associated with vision loss

1) Prevention

2) Provide adequate funding for eye care services for treatable eye conditions

3) Substantial increase in funding for targeted research into

Costs of Vision Loss Australia could save 5 dollars for each dollar spent

Discussion 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 Provides data required to place the needs for eye care in perspective and to compare it with other health priorities This data is specific for Australia, but may provide some information into the situations in the U.S and other developed countries

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

Provides data required to place the needs for eye care in perspective and to compare it with other health priorities

This data is specific for Australia, but may provide some information into the situations in the U.S and other developed countries

Discussion The Australian government committed 14 million to eye health promotion in the May 2006 budget

The Australian government committed 14 million to eye health promotion in the May 2006 budget