The cost of vision loss in Canada. 1. Methodology.

OBJECTIVE: This paper outlines the methodology used to estimate the cost of vision loss in Canada. The results of this study will be presented in a second paper. DESIGN: The cost of vision loss (VL) in Canada was estimated using a prevalence-based approach. This was done by estimating the number of people with VL in a base period (2007) and the costs associated with treating them. The cost estimates included direct health system expenditures on eye conditions that cause VL, as well as other indirect financial costs such as productivity losses. Estimates were also made of the value of the loss of healthy life, measured in Disability Adjusted Life Years or DALY's. To estimate the number of cases of VL in the population, epidemiological data on prevalence rates were applied to population data. The number of cases of VL was stratified by gender, age, ethnicity, severity and cause. The following sources were used for estimating prevalence: Population-based eye studies; Canadian Surveys; Canadian journal articles and research studies; and International Population Based Eye Studies. Direct health costs were obtained primarily from Health Canada and Canadian Institute for Health Information (CIHI) sources, while costs associated with productivity losses were based on employment information compiled by Statistics Canada and on economic theory of productivity loss. Costs related to vision rehabilitation (VR) were obtained from Canadian VR organizations. CONCLUSIONS: This study shows that it is possible to estimate the costs for VL for a country in the absence of ongoing local epidemiological studies.

The cost of vision loss in Canada. 2. Results.

OBJECTIVE: This study was conducted to provide the financial underpinnings necessary for effective planning for the provision of eye health services in Canada. Canada is facing an aging demographic and all the major eye diseases are diseases associated with aging. It is essential that we have information based on the best available data to support national and provincial vision health plans. DESIGN: The design associated with the prevalence-based approach used in this study was outlined previously in detail in The Cost of Vision Loss in Canada: Methodology. METHODS: The methods associated with the prevalence-based approach used in this study were previously outlined in detail in The Cost of Vision Loss in Canada: Methodology. RESULTS: The financial cost of VL in Canada in 2007 was estimated to be $15.8 billion per annum: $8.6 billion (54.6%) represents direct health system expenditure; $4.4 billion (28.0%) was productivity lost due to lower employment, higher absenteeism, and premature death of Canadians with VL; $1.8 billion (11.1%) was the dead weight losses (DWL) from transfers including welfare payments and taxation forgone; $0.7 billion (4.4%) was the value of the care for people with VL; $305 million (1.9%) was other indirect costs such as aids and home modifications and the bring forward of funeral costs. Additionally, the value of the lost well-being (disability and premature death) was estimated at a further $11.7 billion. In per capita terms, this amounts to a financial cost of $19370 per person with VL per annum. Including the value of lost well-being, the cost is $33704 per person per annum. CONCLUSIONS: There is a growing awareness in Canada and around the world of the impact of VL on health costs and on the economy in general. This awareness is supported by the growing number of independent studies on the cost of vision loss both nationally and globally. Because most of these studies are limited by the minimal amount of available data, the overall cost of vision loss is likely underestimated. Nevertheless, this study reports the cost of vision loss in Canada as being greater than previously reported, making the problem even more urgent to address. A comprehensive national vision health plan, that is a coordinated federal, provincial and territorial initiative dealing with all aspects of vision loss prevention, sight restoration, and vision rehabilitation is called for.

Economic impact of primary open-angle glaucoma in Australia.

BACKGROUND: Glaucoma is the World's leading cause of irreversible blindness, and poses serious public health and economic concerns. DESIGN: Review. SAMPLES: Published randomized trials and population-based studies since 1985. METHODS: We report the economic impact of primary open-angle glaucoma and model the effect of changes in detection rates and management strategies. MAIN OUTCOME MEASURES: The cost-effectiveness of different interventions to prevent vision loss from primary open-angle glaucoma was measured in terms of financial cost (Australian dollars) and disability-adjusted life years. RESULTS: The prevalence of glaucoma in Australia is expected to increase from 208 000 in 2005 to 379 000 in 2025 because of the aging population. Health system costs over the same time period are estimated to increase from $AU355 million to $AU784 million. Total costs (health system costs, indirect costs and costs of loss of well-being) will increase from $AU1.9 billion to $AU4.3 billion in Australia. CONCLUSION: Primary open-angle glaucoma poses a significant economic burden, which will increase substantially by 2025. This dynamic model provides a valuable tool for ongoing policy formulation and determining the economic impact of interventions to better prevent visual impairment and blindness from glaucoma.

Economic cost of visual impairment in Japan.

OBJECTIVE: To quantify the total economic cost of visual impairment in Japan. METHODS: A prevalence-based approach was adopted using data on visual impairment, the national health system, and indirect costs to capture the economic impact of visual impairment in 2007. RESULTS: In 2007, visual impairment affected more than 1.64 million people in Japan and cost around yen 8785.4 billion (US $72.8 billion) across the economy, equivalent to 1.7% of Japan's gross domestic product. The loss of well-being (years of life lost from disability and premature mortality) cost yen 5863.6 billion (US $48.6 billion). Direct health system costs were yen 1338.2 billion (US $11.1 billion). Other financial costs were yen 1583.5 billion (US $13.1 billion), including productivity losses, care takers' costs, and efficiency losses from welfare payments and taxes. Community care was the largest component of other financial costs and was composed of paid and unpaid services that provide home and personal care to people with visual impairment. The findings of this study are in line with those of similar studies in Australia and the United States. CONCLUSIONS: Visual impairment imposes substantial costs on society, particularly to individuals with visual impairment and their families. Eliminating or reducing disabilities from visual impairment through public awareness of preventive care, early diagnosis, more intensive disease treatment, and new medical technologies could significantly improve the quality of life for people with visual impairment and their families, while also potentially reducing national health care expenditure and increasing productivity in Japan. The results of this study should provide a first step in helping policymakers evaluate policy effects and to prioritize research expenditures.

Prevalence of visual impairment in the adult Japanese population by cause and severity and future projections.

PURPOSE: To present a comprehensive estimate of the total number of people with visual impairment in the adult Japanese population by age, gender, severity and cause, and to estimate future prevalence based on population projections and expected demographic changes. METHODS: Definitions of visual impairment used in this study were based on the United States criteria. Total visual impairment was calculated as the sum of low vision and blindness. The prevalence estimates were based on input from a number of Japanese epidemiological surveys, census material and official population projections. RESULTS: There were an estimated 1.64 million people with visual impairment in 2007 in Japan. Of these, 187,800 were estimated to be blind. The prevalence of visual impairment in Japan increased with age and half of the people with visual impairment were aged 70 years or older. The leading causes of visual impairment in Japan were glaucoma (24.3%), diabetic retinopathy (20.6%), degenerative myopia (12.2%), age-related macular degeneration (10.9%), and cataract (7.2%). These five major causes comprised three-quarters of all visual impairment. The prevalence of visual impairment was projected to increase from 1.3% of the population in 2007 to 2.0% by 2050. CONCLUSIONS: This comprehensive study presents the prevalence of total visual impairment in the adult Japanese population. The projected increases in the prevalence of visual impairment over time reflect the demographic changes of a declining and aging Japanese population. These projections highlight that the burden of disease due to visual impairment and imposed on society is likely to increase.

Cost of treating otitis media in Australia.

OBJECTIVE: Otitis media (OM) is an inflammation of the middle ear. It is very common and associated with serious complications, including hearing loss. This study aimed to estimate the treatment costs of OM in Australia and the associated burden of disease (in disability-adjusted life-years). METHODS: Little Australia-wide epidemiological information is available, so international studies in the main were used to estimate the incidence and prevalence by age and gender. These were triangulated against the available Australian data. Australian health data sets and data collected from the emergency department of a tertiary pediatric hospital were used to estimate the costs of primary care, pharmaceuticals, pathology and imaging, emergency department presentations, specialists, and admitted hospital care. RESULTS: Excluding the costs of the complications and comorbidities associated with OM, treatment costs for the disease in 2008 were between AUS$100 and 400 million. Visits to general practitioners and medicines constituted a high proportion of these costs. Antibiotic prescribing rates remain high despite clear evidence for a limited benefit from antibiotics for most OM cases and concerns regarding bacterial resistance. CONCLUSION: Treatment costs of OM in Australia are high and can only be estimated within a broad range. Further research on the links between antibiotics for OM and antibiotic resistance, and on the cost-effectiveness of prevention or amelioration of OM would be useful.

Costs of interventions for visual impairment.

PURPOSE: To quantify the economic costs of vision loss in Australia and assess the impact of a costed intervention package to prevent avoidable vision loss. DESIGN: Existing Australian population-based data on prevalence and causes of visual impairment were used, and costs were calculated from published data for the five main causes of visual impairment. METHODS: The cost of vision loss in Australia was determined from the weighted prevalence of visual impairment; unpublished data on the indirect costs of vision; and national databases on health care costs and other economic data. A costed intervention package was developed and its economic impact modeled. Outcome measures were total costs and savings from the interventions. RESULTS: The intervention package would cost AU$188.8 million to implement in its first year but would bring a net return of AU$163.1 million in direct costs in the first year and an overall savings to the country of AU$911.1 million, a 4.8-fold return on investment. CONCLUSIONS: Three-quarters of vision loss is avoidable, and many eye care interventions are cost effective. Even a developed economy cannot afford avoidable vision loss. Priority needs to be given to the prevention and treatment of avoidable vision loss.

Vision loss in Australia.

OBJECTIVE: To assess the prevalence and causes of vision loss in Australia and to project these data into the future. DESIGN: Synthesis of data from two cross-sectional population-based cohort studies--the Melbourne Visual Impairment Project and the Blue Mountains Eye Study--and extrapolation to the entire Australian population. SETTING AND PARTICIPANTS: 8376 community and 533 nursing home residents recruited between 1992 and 1996 in urban and rural Victoria and New South Wales. MAIN OUTCOME MEASURES: Age-standardised prevalence of low vision (visual acuity < 6/12) and blindness (visual acuity < 6/60) (both measured in the best eye, with spectacles if usually worn for distance vision), and their causes for the Australian population for 2000 to 2024, projected from Australian Bureau of Statistics population data. RESULTS: In 2004, 480,300 Australians were estimated to have low vision, including 50,600 with blindness. The most common causes of low vision were undercorrected refractive error (62%), cataract (14%) and age-related macular degeneration (10%). The latter was responsible for almost half of all cases of blindness. The numbers of people with low vision and blindness are projected to almost double by 2024. CONCLUSIONS: Vision loss in Australia is a much bigger problem than is usually recognised; 76% of low vision is caused by uncorrected refractive error or cataract, both readily treatable. However, the prevention and treatment of macular degeneration poses a major challenge.