PharmacoEconomics

, Volume 24, Issue 2, pp 193–205

Evaluation of Non-Medical Costs Associated with Visual Impairment in Four European Countries

France, Italy, Germany and the UK
  • Antoine Lafuma
  • Antoine Brézin
  • Stefania Lopatriello
  • Klaus Hieke
  • Julia Hutchinson
  • Viviane Mimaud
  • Gilles Berdeaux
Original Research Article

Abstract

Introduction

Visual impairment is a severe disability that puts a heavy burden on individuals, families and society. In developed countries, the two major diseases leading to irreversible visual impairment are glaucoma and age-related macular degeneration. Their prevalence will increase dramatically with population aging. The economic consequences of visual impairment are considerable, but have rarely been documented, apart from some ‘top-down’ estimates based on national statistics. We estimated the non-medical costs related to visual impairment in four European countries: France, Italy, Germany and the UK.

Methods

Prevalence rates of visual impairment, defined according to local regulations, were taken from national registers and, for France, from two recent nationwide surveys conducted by the French Institute for National Statistics and Economic Studies (Institut National de la Statistique et des Etudes Economiques [INSEE]). Estimates of the number of non-registered persons were obtained from the literature and expert opinion. Estimates of non-medical costs included institutional care, non-medical devices, residential adaptations, burden on carer, paid home help, loss of income and social allowances related to visual impairment. Unit costs (year 2004) were extracted from national databases and manufacturers. Healthcare professionals were interviewed to estimate the duration of assistance required by visually impaired persons. These durations were used to evaluate the cost of paid assistance at home in the four countries.

Results

The numbers of visually impaired persons were 1.27 million in France, 0.73 million in Germany, 1.03 million in Italy and 1.11 million in the UK, including, respectively, 56%, 11%, 80% and 72% non-registered persons. The frequency of institutionalisation for visually impaired persons were, respectively, 7.8%, 9.6%, 10.9% and 10%. Total annual costs for visually impaired persons were estimated at €10 749 million in France, €9214 million in Germany, €12 069 million in Italy and €15 180 million in the UK. This translated into average annual costs per affected individual of €8434, €12 662, €11 701 and €13 674, respectively. The main cost components of visual impairment in the community were ‘loss of income’ (23–43% of community costs), ‘burden on carer’ (24–39%) and ‘paid assistance’ (13–29%).

Conclusion

Total non-medical costs associated with visual impairment are considerable. The present analysis demonstrates that the preponderant economic consequences of visual impairment lie beyond healthcare systems, and that visual impairment has a considerable negative impact on productivity. Considering the non-medical social dimensions of visual impairment related to the consequent incapacity and dependency should encourage payers to finance health innovations that aim to preserve vision.

Supplementary material

40273_2012_24020193_MOESM1_ESM.pdf (83 kb)
Supplementary material, approximately 85 KB.

References

  1. 1.
    ResnikoffS, Pascolini D, Etya ’ale D, et al. Global data on visual impairment in the year 2002. Bull World Health Organ 2004; 82 (11): 844–851Google Scholar
  2. 2.
    Mathers C, Lopez A, Stein C, et al. Deaths and disease burden by cause: global burden of disease estimates for 2001 by world bank country groups [online]. Available from URL: http://www.fic.nih.gov/dcpp/wps/wp18.pdf [Accessed 2005 Apr 26]
  3. 3.
    OECD. Ageing in OECD countries: a critical policy challenge. Social Policy studies No. 20. Paris: OECD Publishing, 1996Google Scholar
  4. 4.
    Robinson R, Deutcsh J, Jones HS, et al. Unrecognised and unregistered visual impairment. Br J Ophthalmol 1994; 78: 736–740PubMedCrossRefGoogle Scholar
  5. 5.
    Wonnald R, Evans J. Registration of blind and partially sighted people. Br J Ophthalmol 1994; 78: 733–734CrossRefGoogle Scholar
  6. 6.
    Bruce IW, McKennell AC, Walker EC. Blind and partially sighted adults in Britain: the RNIB survey. Vol. 1. London: HMSO, 1991Google Scholar
  7. 7.
    Buch H, Vinding T, La Cour M, et al. The prevalence and causes of bilateral and unilateral blindness in an elderly urban Danish population: the Copenhagen City Eye Study. Acta Ophthalmol Scand 2001; 79 (5): 441–449PubMedCrossRefGoogle Scholar
  8. 8.
    Klaver CC, Wolfs RC, Vingerling JR, et al. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol 1998; 116 (5): 653–658PubMedGoogle Scholar
  9. 9.
    Thylefors B, Negrel AD, Pararajasegaram R, et al. Available data on blindness (update 1994). Ophthal Epidemiol 1995; 2 (1), 5–39CrossRefGoogle Scholar
  10. 10.
    Kocur I, Resnikoff S. Visual impairment and blindness in Europe and their prevention. Br J Ophthalmol 2002; 86: 716–722PubMedCrossRefGoogle Scholar
  11. 11.
    Coffey M, Reidy A, Wormald R, et al. Prevalence of glaucoma in the west of Ireland. Br J Ophthalmol 1993; 77 (1): 17–21PubMedCrossRefGoogle Scholar
  12. 12.
    Smith AF, Smith JG. The economic burden of global blindness: a price too high! Br J Ophthalmol 1996; 80 (4): 276–277PubMedCrossRefGoogle Scholar
  13. 13.
    Wright SE, Keefe JE, Thies LS. Direct costs of blindness in Australia. Clin Exp Ophthalmol 2000; 28 (3): 140–142CrossRefGoogle Scholar
  14. 14.
    Chiang YF, Bassi LJ, Javitt JC. Federal budgetary costs of blindness. Milbank Q 1992; 70 (2): 319–340PubMedCrossRefGoogle Scholar
  15. 15.
    Meads C, Hyde C. What is the cost of blindness? Br J Ophthalmol 2003; 87 (10): 1201–1204PubMedCrossRefGoogle Scholar
  16. 16.
    Frick KD, Foster A. The magnitude and cost of global blindness: an increasing problem that can be alleviated. Am J Ophthalmol 2003; 135 (4): 471–476PubMedCrossRefGoogle Scholar
  17. 17.
    VISION 2020: the right to sight [online]. Available from URL: http://www.v2020.org [Accessed 2005 Oct 12]
  18. 18.
    Brezin A, Lafuma A, Fagnani F, et al. Prevalence and burden of blindness, low vision and visual impairmentin the community: a nation-wide survey. Arch Ophthalmol 2005; 123 (8): 1117–1124PubMedCrossRefGoogle Scholar
  19. 19.
    Brezin A, Lafuma A, Fagnani F, et al. Prevalence and burden of blindness and low vision for subjects living in institutions: a nation-wide survey. Health Qual Life Outcomes 2005; 3 (1): 27PubMedCrossRefGoogle Scholar
  20. 20.
    Brezin A, Lafuma A, Fagnani F, et al. Blindness, low vision and other handicaps as risk factors attached to institutional residence. Br J Ophthalmol 2004; 88 (10): 1330–1337PubMedCrossRefGoogle Scholar
  21. 21.
    Statistisches Bundesamt Deutschland (Federal Office of Statistics). Fachserie 13, Reihe 5.1, 2003 [online]. Available from URL: http://www.destatis.de/ [Accessed 2003 Oct 27]
  22. 22.
    National Institute of Statistics, 1ST AT, 2001 [online]. Available from URL: http://www.istat.it/ [Accessed 2004 Apr 19]
  23. 23.
    Department of Health of the English Government, National Statistics [online]. Available from URL: http://www.dh.gov.uk/Home/fs/en [Accessed 2004 Apr 8]
  24. 24.
    DBSV (Deutscher Blinden- und Sehbehindertenverband) [online]. Available from URL: http://www.dbsv.org [Accessed 2004 Apr 18]
  25. 25.
    DBSV (Deutscher Blinden- und The Royal College of Ophthalmology) [online]. Available from URL: http://www.rcophth.ac.uk [Accessed 2004 Apr 8]
  26. 26.
    Le guide du credit. ler centre independant en credit immobilier et consommation [online]. Available from URL: http://www.guideducredit.com/htmcorps/fichierssimulateurs/notaire.com [Accessed 2004 Apr 8]
  27. 27.
    La cote immo. Les prix du marche immobilier [online]. Available from URL: http://money.msn.fr/immobilier/immobilier/accueil/accueil/default.asp [Accessed 2006 Jan 17]
  28. 28.
    NexDom Le portail de l’immobilier [online]. Available from URL: http://www.nexdomcom/scripts/fr/home/ [Accessed 2003 Nov 15]
  29. 29.
    Dernxo. Tarifbleu blanc rouge [online]. Available from URL: http://www.dernxo.fr/ [Accessed2003 Nov 15]
  30. 30.
    Boissonnat V. Handicaps, incapacités, dépendance. Revue Française des Affaires Sociales 2003; No. 1–2Google Scholar
  31. 31.
    Engel H, Engels D. ISG Sozialforschung und Gesellschaftspolitik GmbH. Case management in various national elderly assistance systems. Publication series of the German Federal Ministry for Family Affairs, Senior Citizens, Women and Youth. Bd 18312. Cologne: Kohlhammer, 2000Google Scholar
  32. 32.
    Castiglioni M. Institutionalised old people: the experience of Italy. European Population Conference; 2001 Jun 7–9; Helsinki, FinlandGoogle Scholar
  33. 33.
    Tinker A. Ageing in the United Kingdom: what does this mean for dentistry? Br Dental J 2003; 194 (7): 369–372CrossRefGoogle Scholar
  34. 34.
    Evangelische Kirche Ludwigsburg. Preisliste Diakomie und Sozialstation [online]. Available from URL: http://www.meinekirche.de/downloads/preisebkk.pdf [Accessed 2003 Nov 24]
  35. 35.
    Ministero della Sanità. Tariffe delle prestazioni di assistenza ospedaliera per acuti erogate in regime di ricovero ordinario e diurno ex d.m 30.06.1997Google Scholar
  36. 36.
    Netten A, Curtis L. The unit costs of health and social care, 2002. Kent: Personal Social Services Research Unit (PSSRU), 2002Google Scholar
  37. 37.
    OECD health data [database on CD ROM]. Paris: IRDES (Institut de Recherche et de Documentation en Economie de la Sante), 2004Google Scholar
  38. 38.
    Guide Dogs for the Blind Association (GDBA). The costs of blindness: an analysis of the costs of visual impairment and blindness in the UK 2003 [online]. Available from URL: http://www.gdba.org.uk [Accessed 2004 Apr 14]Google Scholar
  39. 39.
    Berdeaux G, Lafuma A, Mimaud V. Estimation of nationwide costs of annual assistance attributable to visual impairment, from an activity of daily living questionnaire [abstract]. Value Health 2004; 7 (6): 748–749CrossRefGoogle Scholar
  40. 40.
    AIRP [online]. Available from URL: http://www.airp.org/ [Accessed 2004 Apr 1]
  41. 41.
    Personal Social Services Research Unit (PSSRU) [online]. Available from URL: http://www.pssru.ac.uk/ [Accessed 2004 Apr 1]
  42. 42.
    Netten A, Curtis L. Unit cost and health social care 2003 [online]. Available from URL: http://www.pssru.ac.uk [Accessed 2004 Mar 8]Google Scholar
  43. 43.
    Caisse Nationale de l’ Assurance Maladie des Travailleurs Salariés. Indicateurs statistiques: résultats 2000–2001. Paris: Ed Caisse régionale d’Assurance Maladie de l’Ile de France, 2002Google Scholar
  44. 44.
    Thylefors B, Negrel AD, Pararajasegaram R, et al. Available data on blindness (update 1994). Ophthalmic Epidemiol 1995; 2: 5–39PubMedCrossRefGoogle Scholar
  45. 45.
    Queginer P, Guillaumat L, Gattef C. Epidémiologie de la cécité dans les Bouches-du-Rhone. Approche méthodologique. Bull Soc Ophtalmol Fr 1988; 88: 21–22, 25, 26Google Scholar
  46. 46.
    Coffey M, Reidy A, Wormald R, et al. Prevalence of glaucomain the west of Ireland. Br J Ophthalmol 1993; 77: 17–21PubMedCrossRefGoogle Scholar
  47. 47.
    Klaver CC, Wolfs RC, Vingerling JR, et al. Age-specific prevalence and causes of blindness and visual impairment in an older population: the Rotterdam Study. Arch Ophthalmol 1998; 116: 653–658PubMedGoogle Scholar
  48. 48.
    Causes and prevalence of visual impairment among adults in the United States: the Eye Diseases Prevalence Research Group. Arch Ophthalmol 2004; 122: 477–85Google Scholar
  49. 49.
    Jacabzone S, Carrbois E, Rabine JM. Is the health of older persons in OECD countries improving fast enough to compensate for population ageing? OECD Economic Studies No. 30. Paris: OECD, 2000: 149–190 [online]. Available from URL: http://www.oecd.org/dataoecd/31/20/2732545.pdf [Accessed 2004 Apr 20]Google Scholar
  50. 50.
    Taylor H, Keefe J, Mitchell. The economic impact and cost of vision loss in Australia: Ed Eye research Australia. Melbourne, 2004 Aug [online]. Available from URL: http://www.cera.org.au [Accessed 2004 Mar 1]Google Scholar
  51. 51.
    Bonastre J, Le Pen C, Soubrane G, et al. The burden of agerelated macular degeneration: results of a cohort study in two French referral centres. Pharmacoeconomics 2003; 21 (3): 181–190PubMedCrossRefGoogle Scholar
  52. 52.
    Bonastre J, Le Pen C, Anderson P, et al. The epidemiology, economics and quality of life burden of age related macular degeneration in four European countries: France, Italy, Germany and the United Kingdom. Eur J Health Econ 2002; 3 (2): 94–102PubMedCrossRefGoogle Scholar
  53. 53.
    Denis P, Lafuma A, Berdeaux G. Medical predictive factors of glaucoma treatment costs. J Glaucoma 2004; 13 (4): 283–290PubMedCrossRefGoogle Scholar
  54. 54.
    Jonsson B, Krieglstein G. Primary open-angle glaucoma: differences in international treatment patterns and costs. Oxford: Ed Isis Medical Media, 1999Google Scholar
  55. 55.
    National Institute for Clinical Excellence. Guide to the methods of technology appraisal. London: NICE, 2004 [online]. Available from URL: http://www.nice.org.uk/ [Accessed 2004 Nov 23]Google Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  • Antoine Lafuma
    • 1
  • Antoine Brézin
    • 2
  • Stefania Lopatriello
    • 3
  • Klaus Hieke
    • 4
  • Julia Hutchinson
    • 5
  • Viviane Mimaud
    • 1
  • Gilles Berdeaux
    • 6
  1. 1.Cemka-EvalBourg la ReineFrance
  2. 2.Hopital CochinParisFrance
  3. 3.PBE-ConsultingVeronaItaly
  4. 4.NEOS-HealthBinningenSwitzerland
  5. 5.Fourth Hurdle Consulting LtdLondonUK
  6. 6.Conservatoire National des Arts et MétiersParisFrance
  7. 7.Alcon FranceFrance

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