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Association between Visual Acuity and Medical and Non-Medical Costs in Patients with Wet Age-Related Macular Degeneration in France, Germany and Italy

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Abstract

Introduction

Exudative (‘wet’) age-related macular degeneration (ARMD) is the major cause of blindness in Western developed countries. Treatments aimed at preserving vision are already available and new compounds are under development. Micro-economics information will be pivotal to justifying forthcoming investment.

Objective

This study sought to investigate the costs of exudative ARMD in patients who were actively treated at ophthalmology referral centres in three European countries: France, Germany and Italy.

Method

This cross-sectional observational study was conducted in France, Germany and Italy in 2004. The following data were collected: ARMD description, visual acuity (VA), and the medical and non-medical resources used for ARMD in the preceding year. The economic perspective was that of society. ANOVA for cost variables estimated the impact of ARMD per eye, adjusted for sex and age. Both hospital and ambulatory eye centres were included. Patients with exudative ARMD were stratified into four levels of severity using VA thresholds of 20/200 for the worst eye (WE) and 20/40 for the best eye (BE). The main outcome measure was medical and non-medical costs.

Results

360 patients were included (females 60%; mean age 77 years; mean interval since diagnosis 2.3 years). The two groups with the greatest difference in severity of VA loss consisted of BE ≥20/40, WE ≥20/200 (27.2% of patients) and BE <20/40, WE <20/200 (25.5% of patients). Total cost was two-thirds medical and one-third non-medical. Total costs increased with ARMD severity and were 1.1–2 times greater for severe disease compared with less severe disease. Average medical costs (2004 values) in France were €3714, compared with €1810 in Germany and €2020 in Italy, and showed slight increases with ARMD severity. Non-medical costs were significantly higher for patients with severe disease and highest in Germany.

Conclusion

The impact of ARMD on costs was considerable and a positive correlation was found between total costs and ARMD severity. Differences among countries were partly explained by differences in customary care delivery.

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Acknowledgements

This work was supported by an unrestricted grant from Alcon France SA, Rueil-Malmaison, France and contracted to Aremis, Neuilly-sur-Seine, France, PBE Consulting srl, Milan, Italy and NEOS Health AG, Binningen, Switzerland. Dr Gilles Berdeaux is an employee of Alcon France SA. Dr José-Alain Sahel, Dr Albert Augustin and Dr Francesco Bandello have acted as consultants to Alcon France SA. The other authors have no conflicts of interest that are directly relevant to the content of this study.

The MICMAC Study Group: France: Prof. José Sahel, Hôpital des Quinze/Vingt, Paris; Dr Gilles Chaine, Hôpital Avicenne, Bobigny; Dr Michel Weber, CHU Hôpital Hôtel dieu, Nantes; Dr Gabriel Quentel, Centre Ophta, d’Imagerie et de Laser, Paris; Dr Salomon Yves Cohen, Centre Ophta, d’Imagerie et de Laser, Paris; Dr Martine Mauget-Faysse, Lyon; Prof. Gérard Brasseur, Hôpital Charles Nicole, Rouen; Prof. Jean-François Korobelnik, Groupe hospitalier Pellegrin, Bordeaux; Dr Mustapha Benchaboune, Hôpital Bellevue, St Etienne; Prof. Jean-François Charlin, CHR Rennes, Rennes. Germany: Prof. Augustin, Hospital of Karlsruhe, Karlsruhe; Dr Weinhold, office-based practitioner, Karlsruhe; Dr Kaut, office-based practitioner, Karlsruhe; Dr Hyppa, office-based practitioner, Karlsruhe; Dr Jurgeit, office-based practitioner, Karlsruhe. Italy: Dr Carlo Incorvaia, Clinica Oculistica Arcispedale S. Anna, Ferrara; Prof. Francesco Bandello, Clinica Oculistica Università degli Studi, Udine; Prof. Ugo Menchini (Dr ssa Capobianco), Dipartimento di Scienze Chirurgiche Oto-Neuro-Oftalmologiche Università degli Studi, Firenze; Dr Francesco Boscia, Dipartimento Oftalmologia e Otorinolaringoiatria Policlinico, Bari; Dr Malerba, Clinica Oculistica Università degli Studi, Catania; Dr Setaccioli, Dipartimento di Oculistica e Scienza della Visione, Ospedale San Raffaele, Milano; Dr ssa Monica Varano, Dr Schiano, Fondazione G.B. Bietti per l’Oftalmologia, Roma.

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Authors and Affiliations

  1. University of Udine, Udine, Italy

    Francesco Bandello

  2. Augenklinik, Karlsruhe, Germany

    Albert Augustin

  3. Hôpital des XV-XX, Paris, France

    José-Alain Sahel

  4. Aremis Consultants, Neuilly-sur-Seine, France

    Hicham Benhaddi

  5. PBE Consulting, Verona, Italy

    Cristina Negrini

  6. Neos Health, Basel, Switzerland

    Klaus Hieke

  7. Conservatoire National des Arts et Métiers, Paris, France

    Gilles H. Berdeaux

  8. Alcon France, 4 Rue Henri Sainte-Claire Deville, F-92563, Rueil-Malmaison, France

    Gilles H. Berdeaux

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  1. Francesco Bandello
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  2. Albert Augustin
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MICMAC (Microeconomics of MACular degeneration) Study Group

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Correspondence to Gilles H. Berdeaux.

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Bandello, F., Augustin, A., Sahel, JA. et al. Association between Visual Acuity and Medical and Non-Medical Costs in Patients with Wet Age-Related Macular Degeneration in France, Germany and Italy. Drugs Aging 25, 255–268 (2008). https://doi.org/10.2165/00002512-200825030-00007

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