Economic burden of vision loss estimated in billions
The economic burden of vision loss in the United States was approximately $134.2 billion in 2017, with more than two-thirds of the burden resulting from other medical services, nursing home care and reduced labor force, according to research.
“Vision loss (VL) and blindness result in economic impacts from increased medical costs, a higher risk of nursing home placement and productivity losses,” David B. Rein, PhD, of NORC at the University of Chicago, and colleagues wrote in Ophthalmology. “Estimates could better inform public health policy by focusing on only those costs that result from VL (excluding costs of non-VL eye care), expanding the definition of VL to include anyone with self-reported VL (regardless of whether that VL is correctable) and accounting for state differences in VL prevalence, medical and labor costs.”
Using data from the American Community Survey, the American Time Use Survey, the Bureau of Labor Statistics, the Medical Expenditure Panel Survey, the National and State Health Expenditure Accounts, and the National Health Interview Survey, Rein and colleagues estimated the direct and indirect costs in 2017 by age group, sex and state in total and per person with VL.
Researchers reported that direct costs associated with VL accounted for $98.7 billion, with the greatest burden linked to nursing home costs ($41.8 billion) and medical care services ($30.9 billion).
Conversely, indirect costs — which include absenteeism, lost household production, reduced labor force participation, reduced earnings and informal care — accounted for $35.5 billion, with $16.2 billion of that due to reduced labor force participation.
According to the report, state size and population contributed to a variation in economic burden from state to state: California, New York, Texas, Florida and Pennsylvania had the highest total burden, and Wyoming, Vermont, Alaska, South Dakota and North Dakota had the lowest. California was among the highest states with a VL burden of $13.5 billion, while Wyoming was among the lowest with $191 million.
Age and sex also affected the total burden. Men accounted for 42% of the total burden. Adults between 19 and 64 years of age accounted for 39% of the burden, despite making up 51% of all people with VL, and those 65 years and older generated the greatest amount of burden at 54%, although they made up 41% of people with VL.
Researchers further determined that on a national scale, VL costs $16,838 for each person with VL.
One of the limitations of this study was that estimates did not include costs associated with vision or eye-related services for people without VL. “This narrower perspective is responsible for the lower topline estimate, as compared with earlier work,” researchers wrote.
“Self-reported VL imposes a substantial economic burden on the United States,” Rein and colleagues concluded. “Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on the age composition of the population with VL.
“Information on state variation can help local decisionmakers target resources better to address the burden of VL.”
Perspective
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Conveying the impact of vision loss and need for improved access to care to members of our community and policymakers is a daunting challenge that Rein and colleagues address head on by using the power of economic shock.
Prevalence of vision loss was self-reported and included correctable vision loss and likely excluded individuals with high functionality despite potential contrast sensitivity and visual field loss. Inclusion of children in the analysis highlights the long-term, increasing burden of vision loss beyond the health care sector.
While prescription drug costs and coverage in the United States represent areas where significant enhancements can be made to improve access, direct costs due to prescription care represented less than 8% of total direct health care costs for all age groups combined and only 18% of the total cost of nursing home care.
The significant known disparities in access to preventive care across sociodemographic variables were not directly assessed, nor were the indirect costs associated with physical and emotional health challenges in those with vision loss and their caregivers. An aging population, changes to health care administration and utilization during and post-pandemic, impact of delayed preventive care and the resulting long-term consequences of vision loss and associated economic burden will need to continue to be evaluated and addressed.
Translating the staggering economic burden of vision loss into practical, simplified, discrete categories will provide foundational data to shape meaningful evidence-driven policy and continued development of focused community programs.
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