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The cost and burden of eye diseases and preventable blindness

Deloitte Access Economics

ItalyCopyright 2013 by Deloitte Consulting CVBA. All rights reserved.

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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.

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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

This study quantified the economic impact of blindness and vision loss

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The economic impact was estimated by using the prevalence approach to costing

Type Definition

Direct

HealthcareAll 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

Related financial and non-financial costs

Costs included

Total costsNumber of blind

individuals in 2013

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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 CataractDiabetic

retinopathyGlaucoma Wet AMD

60,700,000 218,513 4,018,527 419,246 984,223 545,184

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Cataract

DR

Glaucoma

Wet AMD

0 20,000 40,000 60,000 80,000 100,000 120,000

Blind Non-blind

DALYs

96,901

34,526

20,206

16,989

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.

* DALYs = Disability-adjusted life years, which represent one lost year of "healthy" life.DR = Diabetic retinopathy, AMD = Age-related macular degeneration

Estimated loss of wellbeing from eye diseases, DALYs in 2013

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Proportion of healthcare costs for blindness by disease (€336.8 million)

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

*Indirect costs are financial impacts on society that are more broadly, outside the health care system.DR = Diabetic retinopathy, AMD = Age-related macular degeneration

Glaucoma10.0%

Cataract0.6%

Wet AMD73.8%

DR15.7%

Italy, €336.8 million

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• 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%)

Productivity68%

Informal care15%

Health17%

Annual costs of blindness by type of costs

As well as a loss in productivity leading to a large economic burden

*Indirect costs are financial impacts on society that are more broadly, outside the health care system.

€2.0 billion

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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.

• 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.

Incremental Cost Effectiveness Ratio

=

Costs new intervention – Costs current intervention

Benefit new intervention – Benefit current intervention

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The costs per outcome were extracted for four interventions and adjusted per country

Four interventions ICER estimation and extrapolation methods

ICERs extracted from studies

Convert to Euros using PPP

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

Max and Min estimated ICERs

Assessed against WHO thresholds for cost-effectiveness1 x GDP = Highly cost effective 3 x GDP = cost effective

ICER = Incremental cost-effectiveness ratioPPP = 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-effectivenessGDP = Gross domestic productDR = Diabetic retinopathy, AMD = Age-related macular degeneration

Screening for cataracts

(+ subsequent treatment)

Screening for Diabetic

Retinopathy (+ subsequent

treatment)

Glaucoma Eye Examination

(+ subsequent treatment)

Anti-VEGF treatment for

wet AMD

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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

Screening for diabetic

retinopathy

Cataract screening

Anti-VEGF for AMD treatment

Interventions worth their investment

DR = Diabetic retinopathy, AMD = Age-related macular degeneration

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• 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

DR screening Screening for glaucoma Anti-VEGF treatment

Blind years DALYs Blind years DALYs Blind years DALYs

Lower limit

Upper limit

24,127

51,855

1,066

3,76050,694

3,723

15,330

19,732

63,800

3,765

28,829

Blind years and DALYs avoided per intervention

Investing in cost-effective interventions has a big impact on reducing disease burden

DR = Diabetic retinopathy

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• Each intervention can offset economic costs of €222m – €1.2bn

These interventions will offset a significant amount of economic costs to society

Insufficient published

information to estimate cost offsets due to

blindness prevention

Cataract screening

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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.