The European Journal of Health Economics

, Volume 11, Issue 6, pp 525–531 | Cite as

The direct, indirect and intangible costs of visual impairment caused by neovascular age-related macular degeneration

Original Paper


Neovascular age-related macular degeneration (nvAMD) is a chronic, progressive disease of the central retina, and its prevalence is expected to rise with the ageing population. Using a bottom-up approach based on retrospective data, this cross-sectional study estimated average annual direct costs of nvAMD to be £4,047, and average annual indirect costs to be £449. An attempt to measure intangible costs through willingness-to-pay yielded a lower response rate and estimated intangible costs to be 11.5% of monthly income. Direct costs were significantly higher for male participants, for those who have mild or moderate visual impairment in both eyes, and for those who have been diagnosed for a shorter time. The findings of this study suggest that the availability of early diagnosis, effective treatment, support services, and sustained research into the management of nvAMD may reduce the burden of visual impairment caused by nvAMD to affected individuals and the state.


Economic costs Neovascular age-related macular degeneration Visual impairment 

JEL Classification




The author would like to thank Dr. C. Cardwell for his statistical advice. This study was funded by the Research and Development Office, Health and Social Services Central Services Agency, Northern Ireland.


  1. 1.
    Resnikoff, S., Pascolini, D., Etya’ale, D., Kocur, I., et al.: Global data on visual impairment in the year 2002. Bull. World Health Organ. 82, 844–852 (2004)Google Scholar
  2. 2.
    Smith, W., Assink, J., Klein, R., Mitchell, P., Klaver, C.C., Klein, B.E., et al.: Risks factors for age-related macular degeneration: pooled findings from three continents. Ophthalmology 108, 697–704 (2001)CrossRefGoogle Scholar
  3. 3.
    Evans, J.R.: Risk factors for age-related macular degeneration. Prog. Retin. Eye Res. 20(2), 227–253 (2001)CrossRefGoogle Scholar
  4. 4.
    Lamoureux, E.L., Hassell, J.B., Keeffe, J.E.: The determinants of participation in activities of daily living in people with impaired vision. Am. J. Ophthalmol. 137, 265–270 (2004)CrossRefGoogle Scholar
  5. 5.
    Bonastre, J., Le Pen, C., Soubrane, G., Quentel, G.: The burden of age-related macular degeneration: results of a cohort study in two French referral centres. Pharmacoeconomics 21, 181–190 (2003)CrossRefGoogle Scholar
  6. 6.
    Coleman, A.L., Yu, F.: Eye-related medicare costs for patients with age-related macular degeneration from 1995 to 1999. Ophthalmology 115, 18–25 (2008)CrossRefGoogle Scholar
  7. 7.
    Cruess, A., Zlateva, G., Xu, X., Rochon, S.: Burden of illness of neovascular age-related macular degeneration in Canada. Can. J. Ophthalmol. 42, 836–843 (2007)CrossRefGoogle Scholar
  8. 8.
    Cruess, A.F., Zlateva, G., Xu, X., Soubrane, G., Pauleikhoff, D., Lotery, A., Mones, J., Buggage, R., Schaefer, C., Knight, T., Goss, T.F.: Economic burden of bilateral neovascular age-related macular degeneration: multi-country observational study. Pharmacoeconomics 26, 57–73 (2008)CrossRefGoogle Scholar
  9. 9.
    Garattini, L., Castelnuovo, E., Lanzetta, P., Viscarra, C., Ricci, E., Parazzini, F., et al.: Direct medical costs of age-related macular degeneration in Italian hospital ophthalmology departments. A multicenter, prospective 1-year study. Eur. J. Health Econ. 5, 22–27 (2004)CrossRefGoogle Scholar
  10. 10.
    Halpern, M.T., Schmier, J.K., Covert, D., Venkataraman, K.: Resource utilization and costs of age-related macular degeneration. Health Care Financ. Rev. 27, 37–47 (2006)Google Scholar
  11. 11.
    Lotery, A., Xu, X., Zlatava, G., Loftus, J.: Burden of illness, visual impairment and health resource utilisation of patients with neovascular age-related macular degeneration: results from the UK cohort of a five-country cross-sectional study. Br. J. Ophthalmol. 91, 1303–1307 (2007)CrossRefGoogle Scholar
  12. 12.
    Schmier, J.K., Halpern, M.T., Covert, D., Delgado, J., Sharma, S.: Impact of visual impairment on use of caregiving by individuals with age-related macular degeneration. Retina 26, 1056–1062 (2006)CrossRefGoogle Scholar
  13. 13.
    Schmier, J.K., Halpern, M.T., Covert, D.W., Delgado, J., Sharma, S.: Impact of visual impairment on service and device use by individuals with age-related macular degeneration (AMD). Disabil. Rehabil. 28, 1331–1337 (2006)CrossRefGoogle Scholar
  14. 14.
    Curtis, L., Netten, A.: Unit costs of health and social care 2006. Personal Social Services Research Unit, Canterbury (2006)Google Scholar
  15. 15.
    UK House of Commons.: Daily hansard: Written answers for 31 January 2006—meals on wheels. [Online] (2006). Accessed 12 Nov 2006
  16. 16.
    AA Motoring Trust: The cost of motoring—2006. AA Motoring Trust, London (2006)Google Scholar
  17. 17.
    Department of Enterprise, Trade, and Investment, Northern Ireland.: Northern Ireland annual survey of hours and earning 2006. Retrieved 12 November, 2006, from (2006)
  18. 18.
    Owen, C.G., Fletcher, A.E., Donoghue, M., Rudnicka, A.R.: How big is the burden of visual loss caused by age related macular degeneration in the United Kingdom? Br. J. Ophthalmol. 87(3), 312–317 (2003)CrossRefGoogle Scholar
  19. 19.
    Government Actuary’s Department (UK).: Projected population at mid-years by age last birthday in five-year age bands. [Online} (2007). Accessed Oct 2007
  20. 20.
    Amoaku, W.M.K.: The Royal College of Ophthalmologists interim recommendations for the management of patients with age-related macular degeneration. Version 2. The Royal College of Ophthalmologists, London (2007)Google Scholar
  21. 21.
    National Institute for Clinical Excellence (NICE): Technology appraisal 68: guidance on the use of photodynamic therapy for age-related macular degeneration. NICE, London (2003)Google Scholar
  22. 22.
    Verteporfin Roundtable 2000 and 2001 Participants.: Treatment of age-related macular degeneration with photodynamic therapy (TAP) study group principal investigators, & Verteporfin in photodynamic therapy (VIP) study group principal investigators. Guidelines for using verteporfin (visudyne) in photodynamic therapy to treat choroidal neovascularization due to age-related macular degeneration and other causes. Retina 22, 6–18 (2002)Google Scholar
  23. 23.
    Gupta, O.P., Brown, G.C., Brown, M.M.: Age-related macular degeneration: the costs to society and the patient. Curr. Opin. Ophthalmol. 18, 201–205 (2007)CrossRefGoogle Scholar
  24. 24.
    Ke, K.M., Chakravarthy, U., O’Neill, C.: Economic cost of age-related macular degeneration: a review of recent research. Drugs Aging 23, 217–225 (2006)CrossRefGoogle Scholar
  25. 25.
    Romans, F.: The transition of women and men from work to retirement. No. 97/2007. Eurostat, Luxembourg (2007)Google Scholar
  26. 26.
    U.S. Department of Labor.: Labour force statistics from current population survey (CPS). [Online] (2007). Accessed 5 Oct 2007
  27. 27.
    Kahneman, D., Ritov, I., Schkade, D.A.: Economic preferences or attitude expressions?: an analysis of dollar responses to public issues. J. Risk. Uncertain. 19, 203–235 (1999)CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Department of Oral and Dental Science, Bristol Dental SchoolUniversity of BristolBristolUK

Personalised recommendations