Prevention, Treatment,
and Rehabilitation; a
Three-pronged
Approach to
Optimizing Visual
Health
David Rein
Presented at: Committee on the Public Health
Approaches to Reduce Vision Impairment and
Promote Eye Health. Section 5, Perspectives on
Policy and Systems Change
Washington, DC
7/27/2015
Cyclical Nature of Public
Health Policy
Formative:
Agenda &
Priority Setting
Action:
Implementation
Economic Burden
Studies
Deliberative:
Decision
Making
2
Uses of Economic Burden
Studies In Public Health
• External Uses (outside the field)
• Draw attention
• Compare and contrast with other conditions
• Motivate policy responses
• Internal Uses (within the field)
• Categorization and Prioritization
– By condition. population, region
• Actions can be set in motion based on what is
included or excluded from the study
• Alternatively, aggregate burden can be used to
motivate action on minor or unalterable problems
3
Burden of Visual Disorders
• Funded by Prevent Blindness and released in
2013
• Conducted by NORC (Wittenborn & Rein)
• Intended to be inclusive of multiple conditions,
and cost implications of visual outcomes
• Web-enabled
costofvision.preventblindness.org
4
2013 Burden of Visual
Disorders – By Cost Category
• $139 billion
long term care,
$20.2
other indirect,
$3.5
other direct,
$1.7
medical, $65.0
productivity,
$48.4
Source: Wittenborn JS, Rein DB. Cost of vision problems: the economic burden of vision loss and eye disorders in the
United States. NORC at the University of Chicago. Prepared for Prevent Blindness America,
Chicago, IL, 2013. Available at: http://costofvision.preventblindness.org.
5
2013 Direct Medical Cost by
Condition, Total = $65 bn
Other
disorders, $4.5
Glaucoma and
optic nerve,
Refractive error,
$5.8
$16.1
Physical
disorders, $8.9
Cataracts,
$10.7
Retinal
disorders, $8.7
Vision
problems,
$10.4
Source: Wittenborn JS, Rein DB. Cost of vision problems: the economic burden of vision loss and eye disorders in the
United States. NORC at the University of Chicago. Prepared for Prevent Blindness America,
Chicago, IL, 2013. Available at: http://costofvision.preventblindness.org.
6
In Context
Direct Medical Costs Only
Condition
Heart Conditions
Visual Disorders
Cancer
Mental Disorders
Pulmonary Conditions
Hypertension
Diabetes
Stroke
Direct Medical Cost
85.4
65.0
61.0
59.9
58.0
46.1
35.7
20.7
Source of other condition costs: Agency for Healthcare Research and Quality. Total expenses for conditions by site of
service: United States, 2003. Medical Expenditure Panel Survey Component Data.
7
2013 Burden By Age Group
$90
Indirect Costs
$80
Direct Costs
Cost in Billions
$70
$60
46.94
$50
$40
$30
11.55
$20
$10
$0
13.08
0.65
5.09
9.09
0-17
18-39
22.25
40-64
30.33
65+
Source: Wittenborn JS, Rein DB. Cost of vision problems: the economic burden of vision loss and eye disorders in the
United States. NORC at the University of Chicago. Prepared for Prevent Blindness America,
Chicago, IL, 2013. Available at: http://costofvision.preventblindness.org.
8
2013 Burden by Category:
Direct Costs
Diagnosed Medical Cost
Medical Vision Aids
Undiagnosed Vision Loss
Assitive Devices
Education/School Screening
Assistance Programs
$0
$20
$40
$60
Source: Wittenborn JS, Rein DB. Cost of vision problems: the economic burden of vision loss and eye disorders in the
United States. NORC at the University of Chicago. Prepared for Prevent Blindness America,
Chicago, IL, 2013. Available at: http://costofvision.preventblindness.org.
9
2013 Burden by Category:
Indirect Costs
Productivity Loss
Nursing Home
Entitlements and tax deductions*
Informal Care
Transfer Deadweight Loss
$0
$20
$40
$60
Source: Wittenborn JS, Rein DB. Cost of vision problems: the economic burden of vision loss and eye disorders in the
United States. NORC at the University of Chicago. Prepared for Prevent Blindness America,
Chicago, IL, 2013. Available at: http://costofvision.preventblindness.org.
10
Research gaps related to
burden
• Published Visual Health Research July 5, 2008
to July 3, 2013, indexed in PubMed
• Used a list of visual health related search terms
to identify research and commentary
• 134,582 articles related to visual health
• Gaps
• Refractive errors: 7.4% of articles
• Rehabilitation/adaptation: 2.3% of articles
• Productivity: 1.4% of articles
• Long term care: 0.5% of articles
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Similar Gaps in Health
Economic Studies
Search Term
Economics + Prior Terms
Cost-effectiveness or
Cost-benefit
Insurance or Actuarial
Number of Articles
Percent of Total
1,190
259
100.0%
21.8%
229
19.2%
123
10.3%
Burden
90
7.6%
Long Term Care
64
5.4%
Implementation
62
5.2%
Utility
55
4.6%
Productivity
41
3.4%
Resource Allocation
22
1.8%
Value of Information
11
0.9%
1
0.1%
Utilization
Return on Investment
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Implications
• Visual health is costly
• among the most costly health conditions in the US
• Medical Tx & innovation is important
• Assuring affordable refraction, and effective,
evidence based rehabilitation, and adaptation
are as important
• Indirect costs exceed direct costs
• Without insurance or government reimbursement,
market-based solutions to avert productivity losses
and long term care costs are unlikely to emerge
• Market failure, motivation for government action
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Questions
• How can society maximize the quality and
quantity of visual perception?
• How can society minimize the personal and
family impact of impairment among those
afflicted?
• What private organizations and/or governmental
bodies are best positioned to address these
issues?
• What tools are available to these organizations?
14
Acknowledgements and
Resources
• John Wittenborn, NORC
• Developed the revised burden estimates
• Prevent Blindness
http://costofvision.preventblindness.org/
• Rein, DB. (2013) ‘Vision Problems Are a Leading
Source of Modifiable Health Expenditures’. IOVS,
54:14, 18-22.
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David Rein, rein-david@norc.org
Thank You!