Adult visual problems cost U.S. $51.4 billion a year, research finds

Main goal of report to secure federal funding for eye disease research and prevention measures, Prevent Blindness America executive says.

A new report estimates that the annual cost associated with adult vision problems in the United States is $51.4 billion, according to a press release from Prevent Blindness America, the nonprofit organization that funded the research.

Two groups of health economists collaborated on the research effort. David B. Rein, PhD, of RTI International, and colleagues at the Centers for Disease Control and Prevention determined that vision impairment and blindness cost the U.S. economy $35.4 billion each year. The second research team, led by Kevin D. Frick, PhD, of Johns Hopkins Bloomberg School of Public Health, estimated the financial impact to individuals, caregivers and others at $16 billion. The combined total financial impact equaled $51.4 billion, according to the release.

Kevin D. Frick

The report is the third in a series published by Prevent Blindness America. The organization’s first report, published in 2002, addressed the prevalence of eye disease in the United States. The second report laid out a plan of action to address the findings of the first report.

The third report “finally puts an accurate price tag on what we have been hammering for: more federal funding for research and prevention programs that focus on blindness and vision loss treatment and prevention,” Daniel Garrett, senior vice president of Prevent Blindness America, told Ocular Surgery News in an interview. “We now know how much it’s costing us directly and indirectly to treat these age-related eye diseases.”

Prevent Blindness America held a symposium April 18 in Washington, D.C., during which it presented the report to Capitol Hill staffers.

“This is just a part of our ongoing efforts to educate lawmakers on eye diseases and their impact. This report will be a big piece of artillery for our work on the Hill,” Mr. Garret said.

“The next step is to make sure the National Eye Institute receives $711 million for research next year, as well as ensuring that the Centers for Disease Control and Prevention receives $4 million for the vision program,” he said.

He noted that winning support for blindness prevention programs is the chief goal of the report, adding that much of the $51.4 billion in annual costs could be averted.

“There’s not a scientific number, but I think it could be significantly reduced, given the fact that half of all blindness is preventable,” he said.

Cost to U.S. economy

The study by Dr. Rein and colleagues concluded that vision impairment cost the U.S. economy $35.4 billion in 2004. They reviewed more than 2.5 million Medicare claims for the analysis, which was published in Archives of Ophthalmology.

The researchers examined three ways that vision disorders affect the economy: direct medical costs, losses in productivity and other direct costs, such as nursing home care or guide dogs for the blind. Vision disorders, as defined for the study, included visual impairment, blindness, refractive error, age-related macular degeneration, cataracts, diabetic retinopathy and primary open-angle glaucoma.

In 2004, visual impairment and blindness affected more than 3.6 million Americans, the authors said. Of the $35.4 billion, $16.2 billion was associated with direct medical costs — roughly $6.8 billion for cataracts, $5.5 billion for refractive error, $2.9 billion for glaucoma, $575 million for AMD and $493 million for diabetic retinopathy. Most of the direct medical costs were for pharmaceuticals and for outpatient services for cataracts and refractive error, the authors noted. Because the analysis was based on data from 2004, it did not take into account the cost of recent anti-vascular endothelial growth factor treatments for AMD, the report said.

The researchers estimated that $11.2 billion was associated with other direct costs, of which $11 billion were nursing home fees. The report noted that while only 4.3% of U.S. adults aged 65 or older live in nursing homes, the proportion of adults with visual impairment and blindness in nursing homes was 16% and 40%, respectively.

The financial toll of productivity loss, calculated from the Survey of Income and Program Participation, amounted to $8 billion, the authors said; these costs resulted from a smaller labor population and lower wages due to visual impairment.

Cost to individuals, caregivers and others

The study by Dr. Frick and colleagues concluded that blindness and visual impairment cost individuals, caregivers and other health care payers $16 billion annually.

Dr. Frick pooled data from the 1996 to 2002 Medical Expenditure Panel Surveys for the analysis, which was also published in Archives of Ophthalmology.

“The Medical Expenditure Panel Survey offers data on a nationally representative sample,” Dr. Frick told OSN. “There are few nationally representative samples that have a large number of blind or visually impaired people that you can analyze like this.”

Dr. Frick and colleagues divided costs into three categories: excess medical care expenditures, including outpatient doctor visits and home health care; informal care costs, referring to unpaid care provided by friends or family members; and a financial measure of quality of life.

The researchers found that excess medical costs totaled $5.12 billion. The majority of this amount was tied to home health care expenses, they said. Compared with fully sighted individuals, people with visual impairment spent more than $1,000 more on excess medical care. Blind individuals spent more than $2,000 more, the report said.

“Home health services in this case may be relatively informal,” Dr. Frick said. “It’s not like a cardiac patient, where they’re bringing in oxygen every day. It can be helping them keep their house in order.

“I would have thought that [continuing care of the eye] or extra hospitalizations might be where most of the extra care was. But instead, within the community dwelling population, we’re finding that the most important thing is the expense to keep them in the community,” he said.

Informal care costs totaled $360 million and the loss in quality of life totaled $10.5 billion. For the quality-of-life loss, Dr. Frick multiplied a total of 209,200 quality-adjusted-life-years by $50,000 per year, a standard U.S. value, the report said.

Home health care vs. nursing homes

Dr. Frick pointed out that even though home health care costs visually impaired individuals thousands of dollars annually, it is essential for defraying nursing home costs, which are often exponentially higher.

“We have a system where, for better or for worse, once you need nursing home care, eventually it will be picked up by Medicaid if you’re there long enough,” Dr. Frick said. “[Home health care services] are preventative in that they’re keeping [patients] out of a nursing home. That would cost a heck of a lot more than keeping them at home and paying a couple of thousand dollars a year on home health care.”

He noted that his research group is still analyzing data to learn about the barriers that are preventing blind or visually impaired individuals from accessing home health care.

“Are they spending as much as they could have if they had gotten all the care that they needed in a timely way? Or maybe the reason that they’re spending more is because they’re not getting care in a timely way and it could have been prevented,” Dr. Frick said.

In an ideal world, he said government policies would facilitate access to home health care for blind or visually impaired individuals. However, he noted, such policies in practice often stray from their original intent.

“Past studies have shown that when you offer home care, you not only get the group you thought was going to use it, but you get other people as well, and it ends up being more expensive rather than less expensive,” Dr. Frick said. “So it’s a tricky thing to think about. But I would hope [my research] would be used to think about policies to facilitate access to non-institutional care for blind and visually impaired people.”

He suggests that ophthalmologists should re-examine what their role should be when they can no longer improve their patients’ vision.

“What are the other services to which [ophthalmologists] can link [their patients], or is it even their role to link them? That’s a professional question for ophthalmologists,” he said. “Maybe patients need more recommendations and counseling referrals from their ophthalmologists to go out and get therapeutic or home care that could keep them in the community.”

For more information:

• Kevin D. Frick, PhD, can be reached at Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 606, Baltimore, MD; 410-614-4018; fax: 410-955-0470; e-mail: kfrick@jhsph.edu.
• Daniel Garrett, senior vice president of Prevent Blindness America, can be reached at 211 W. Wacker Drive, Suite 1700, Chicago, IL 60606; 800-331-2020; e-mail: dgarrett@preventblindness.org.

References:

• Frick KD, Gower EW, Kempen JH, Wolff JL. Economic impact of visual impairment and blindness in the United States. Arch Ophthalmol. 2007;125:544-550.
• Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol. 2006;124:1754-1760.

• Andy Moskowitz is an OSN Staff Writer who covers all aspects of ophthalmology.