The cost and burden of eye diseases
and preventable blindness
Deloitte Access Economics
Italy
Copyright 2013 by Deloitte Consulting CVBA. All rights reserved.
This document is intended to provide general information on a particular subject or subjects and is not an exhaustive treatment of such
subject(s). Accordingly, the information in this document is not intended to constitute accounting, tax, legal, investment, consulting or other
professional advice or services. Before making any decision or taking any action that might affect your personal finances or business, you
should consult a qualified professional adviser.
This document and the information contained herein is provided "as is," and Deloitte Consulting CVBA makes no express or implied
representations or warranties regarding this document or the information. Without limiting the foregoing, Deloitte Consulting CVBA does not
warrant that the document or information will be error-free or will meet any particular criteria of performance or quality. Deloitte Consulting
CVBA expressly disclaims all implied warranties, including, without limitation, warranties of merchantability, title, fitness for a particular
purpose, non-infringement, compatibility, security, and accuracy.
Your use of this document and information is at your own risk. You assume full responsibility and risk of loss resulting from the use of this
document or information. None of Deloitte Consulting CVBA, or any Deloitte Entities will be liable for any special, indirect, incidental,
consequential, or punitive damages or any other damages whatsoever, whether in an action of contract, statute, tort (including, without
limitation, negligence), or otherwise, relating to the use of this document or information.
1
Executive Summary
 Vision loss affects a large and growing number of
individuals.
 These individuals are impacted by reduced wellbeing
and quality of life.
 Leading to a loss in productivity and a large economic
burden to society.
 By investing in cost-effective interventions, vision loss
will be avoided.
 Resulting in a healthier, happier and more productive
population.
This study quantified the economic
impact of blindness and vision loss
Four eye diseases
• Glaucoma
• Diabetic retinopathy
• Cataract
• Wet age-related macular degeneration
Seven countries
• Phase I – Italy and Germany
• Phase II – France, UK, Spain and Slovakia
• Phase III – Poland
• Study Completion – end of November
Definition of blindness
• For Italy, best corrected visual acuity of less than 3/60 (WHO)
Three outcomes
• Burden of disease
• Economic costs of disease
• Cost effectiveness of interventions that can prevent or delay progression to blindness
3
The economic impact was estimated by
using the prevalence approach to costing
Total costs
Number of blind
individuals in 2013
Related financial and
non-financial costs
Costs included
Type
Definition
Direct
Healthcare
All costs within the healthcare system paid by government or other payers (incl.
patients)
Indirect
Productivity
Income losses due to blindness for individuals of working age (15-64 years)
Informal care
Opportunity costs due to time spent on the provision of care for next of kin
4
Vision loss affects a large and growing
number of individuals
• Italy has a population of 60.7 million, and out of this population
218,513 individuals are considered blind according to the WHO
definition (BCVA <3/60) (prevalence rate of 0.36%).
• Many people in Italy suffer from cataract, diabetic retinopathy (DR),
glaucoma, or wet age-related macular degeneration (AMD).
• As the working population ages, more individuals will be affected by
vision loss leading to productivity losses.
Prevalence of blindness and eye disease (number of people affected)
Population
Blindness
Cataract
Diabetic
retinopathy
Glaucoma
Wet AMD
60,700,000
218,513
4,018,527
419,246
984,223
545,184
5
Individuals with eye diseases have a
significantly reduced quality of life
• A DALY represent one lost year of "healthy" life. The sum of these
DALYs across the population, or the burden of disease, quantifies the gap
between current health status and an ideal health situation.
• Each individual eye disease leads to a significant reduction in DALYs.
• Within eye diseases, wet AMD leads to the largest loss in quality of life.
• The total loss in wellbeing is equivalent to 0.75% of the workforce in 2013.
Estimated loss of wellbeing from eye diseases, DALYs in 2013
Wet AMD
Blind
96,901
Non-blind
34,526
Glaucoma
20,206
DR
16,989
Cataract
0
20,000
40,000
60,000
DALYs
80,000
* DALYs = Disability-adjusted life years, which represent one lost year of "healthy" life.
DR = Diabetic retinopathy, AMD = Age-related macular degeneration
100,000
120,000
6
These eye diseases also induce a large
amount of healthcare costs
• The direct healthcare costs of blindness are €336.8 million
(€1,541 per blind person) in Italy.
• Most of these costs (73.8%) are related to wet AMD
Proportion of healthcare costs for blindness by disease (€336.8 million)
Italy, €336.8 million
DR
15.7%
Glaucoma
10.0%
Cataract
0.6%
Wet AMD
73.8%
*Indirect costs are financial impacts on society that are more broadly, outside the health care system.
DR = Diabetic retinopathy, AMD = Age-related macular degeneration
7
As well as a loss in productivity leading to
a large economic burden
• Blindness results in annual economic costs (direct and indirect*) of
just over €2.0 billion in Italy (€9,309 per blind person)
• Bulk of these costs are estimated to be due to informal care
provision for blind people (68%)
Annual costs of blindness by type of costs
€2.0 billion
Health
17%
Informal care
15%
Productivity
68%
*Indirect costs are financial impacts on society that are more broadly, outside the health care system.
8
The economic impact of interventions was
measured by cost-effectiveness analysis
•
Economic evaluation is the comparative analysis of alternative
interventions in terms of both their costs and consequences in
order to assist policy decisions.
Incremental Cost
Effectiveness Ratio
•
•
Costs new intervention – Costs current intervention
=
Benefit new intervention – Benefit current intervention
The cost effectiveness of interventions are assessed using incremental
cost effectiveness ratios (ICER), specifically the cost per DALY averted.
The WHO uses GDP as a readily available indicator to define three
categories to assess whether interventions are worth their investment:
– highly cost effective: cost per DALY averted less than GDP per capita;
– cost effective: cost per DALY averted between one and three times GDP
per capita; and
– not cost effective: cost per DALY averted more than three times GDP per
capita.
9
The costs per outcome were extracted for
four interventions and adjusted per country
Four interventions
Screening for
cataracts
(+ subsequent
treatment)
Glaucoma Eye
Examination
(+ subsequent
treatment)
ICER estimation and extrapolation methods
Screening for
Diabetic
Retinopathy
(+ subsequent
treatment)
Anti-VEGF
treatment for
wet AMD
ICER = Incremental cost-effectiveness ratio
PPP = Purchasing power parity (An economic theory that estimates the
amount of adjustment needed on the exchange rate between countries)
CPI = Consumer price index, C/E = Cost-effectiveness
GDP = Gross domestic product
DR = Diabetic retinopathy, AMD = Age-related macular degeneration
ICERs extracted
from studies
Convert to Euros
using PPP
Max and Min
estimated ICERs
Inflate to 2013 price
using CPI
GDP per capita
adjustment
Estimated ICERs
for countries with
C/E studies
Extrapolated ICERs
for countries without
C/E studies
Assessed against WHO
thresholds for cost-effectiveness
1 x GDP = Highly cost effective
3 x GDP = cost effective
10
Three out of four interventions were
considered worth their investment
•
•
•
Highly cost effective: Dilated eye evaluation to detect and treat cataracts
(AMD, glaucoma and uncorrected refractive errors)
Cost effective: Anti-VEGF treatment for wet AMD
May not be cost effective: Technician-led glaucoma screening program for
individuals aged >40 years if the prevalence is <4%
Glaucoma
screening
Interventions worth their investment
Screening for
diabetic
retinopathy
Cataract
screening
Anti-VEGF for
AMD treatment
11
DR = Diabetic retinopathy, AMD = Age-related macular degeneration
Investing in cost-effective interventions has
a big impact on reducing disease burden
• Implementing DR screening (and subsequent treatment), screening
for glaucoma (and subsequent treatment), and anti-VEGF treatment
will result in prevention of up to 50,694 – 63,800 blind years per
intervention
• This will avert up to 3,760 – 28,829 DALYs per intervention
Blind years and DALYs avoided per intervention
DR screening
Blind years
DALYs
Lower limit
24,127
1,066
Upper limit
51,855
3,760
DR = Diabetic retinopathy
Screening for glaucoma
Blind years
50,694
DALYs
Anti-VEGF treatment
Blind years
DALYs
3,723
19,732
3,765
15,330
63,800
28,829
12
These interventions will offset a significant
amount of economic costs to society
• Each intervention can offset economic costs of €222m – €1.2bn
Cataract screening
Insufficient
published
information to
estimate cost
offsets due to
blindness
prevention
13
Vision loss can be avoided, resulting in a
healthier and more productive population
 Blindness and vision loss lead to reduced quality of life and increased
economic burden to society.
–
–
–
–
–
In Italy, 218,513 individuals are considered blind.
Vision loss among the workforce due to aging leads to decreased productivity.
Eye diseases lead to a significant reduction of 16,989 – 96,901 DALYs.
Economic burden of blindness to society is €2.0 billion.
Cost-effective interventions offset economic costs of €222m – €1.2bn.
 Investing in cost-effective interventions will lead to a healthier population,
resulting in:
– Reduced healthcare expenditure and more sustainable healthcare budget;
– Increased tax-paying workforce that has increased productivity and has a
longer working life;
– Decreased costs and burden to informal care givers; and
– Improved wellbeing and costs to patients.
 Inclusion of screening, early diagnosis and adequate treatment of
vision loss should be a health policy priority.
14