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The Burden of Age-Related Macular Degeneration

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Abstract

As age-related macular degeneration (AMD) becomes more prevalent as a result of longer life expectancy and the number of elderly people worldwide, it will become increasingly important to understand its potential health and economic impact for appropriate healthcare planning. This review identified published literature on costs and resource use associated with AMD.

Despite the increasing prevalence of AMD, the worldwide burden of illness is unknown. Several studies of direct medical costs, both those associated with ophthalmic care and those associated with other care, have been conducted and have identified increased medical care associated with AMD. Direct non-medical costs include the cost for vision aids; while these costs may be substantial, they are difficult to quantify as no comprehensive sources track the distribution or use of vision aids. Because AMD is uncommon among people of working age, there is less concern regarding the impact of indirect (workplace) costs among AMD patients. However, indirect costs are incurred by caregivers who leave the workforce early or change their work patterns in order to provide assistance to AMD patients; the magnitude of caregiver-related costs is unknown.

The cost effectiveness of some interventions for AMD has been explored. Supplementation with zinc and antioxidants for non-exudative (dry) AMD has been shown to result in an acceptable cost per QALY and is considered cost effective. Studies suggest that laser photocoagulation is cost effective but that photodynamic therapy with verteporfin appears to be cost effective only among patients with good visual acuity at baseline or when models extend longer than 5 years.

Further research is needed to integrate the information on various components of AMD-related costs into a comprehensive burden of illness estimate and to evaluate basic utility assumptions in existing models.

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References

  1. la Cour M, Kiilgaard JF, Nissen MH. Age-related macular degeneration: epidemiology and optimal treatment. Drugs Aging 2002; 19 (2): 101–133

    Article  PubMed  Google Scholar 

  2. Augood C, Aetcher A, Bentham G, et al. Methods for a population-based study of the prevalence of and risk factors for age-related maculopathy and macular degeneration in elderly European populations: the EUREYE study. Ophthalmic Epidemiol 2004 Apr; 11 (2): 117–129

    Article  PubMed  Google Scholar 

  3. Darzins P, Mitchell P, Heller RF. Sun exposure and age-related macular degeneration: an Australian case-control study. Ophthalmology 1997 May; 104 (5): 770–776

    PubMed  CAS  Google Scholar 

  4. Tomany SC, Wang JJ, Van Leeuwen R, et al. Risk factors for incident age-related macular degeneration: pooled findings from 3 continents. Ophthalmology 2004 Jul; 111 (7): 1280–1287

    Article  PubMed  Google Scholar 

  5. Congdon N, O’Colmain B, Klaver CC, et al. Causes and prevalence of visual impairment among adults in the United States. Arch Ophthalmol 2004 Apr; 122 (4): 477–485

    Article  PubMed  Google Scholar 

  6. Ellwein LB, Urato CJ. Use of eye care and associated charges among the Medicare population: 1991–1998. Arch Ophthalmol 2002 Jun; 120 (6): 804–811

    Article  PubMed  Google Scholar 

  7. AREDS Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta carotene, and zinc for age-related macular degeneration and vision loss: AREDS report no. 8. Arch Ophthalmol 2001 Oct; 119 (10): 1417–1436

    Article  Google Scholar 

  8. O’Neill C, Jamison J, McCulloch D, et al. Age-related macular degeneration: cost-of-illness issues. Drugs Aging 2001; 18 (4): 233–241

    Article  Google Scholar 

  9. Hopley C, Carter R, Mitchell P. Measurement of the economic impact of visual impairment from age-related macular degeneration in Australia. Clin Experiment Ophthalmol 2003 Dec; 31 (6), 522–529

    Article  PubMed  Google Scholar 

  10. Frenkel M. Ophthalmologic services as a cOfIllonent of Medicare spending. Arch Ophthalmol 1986 Nov; 104 (11): 1609–1610

    Article  PubMed  CAS  Google Scholar 

  11. Ellwein LB, Friedlin V, McBean AM, et al. Use of eye care services among the 1991 Medicare population. Ophthalmology 1996 Nov; 103 (11): 1732–1743

    PubMed  CAS  Google Scholar 

  12. Javitt JC, Wang F, McBean AM, et al. The use and costs of physician services for ophthalmic surgical procedures in 1988 and 1991. Ophthalmic Surg Lasers 1996 Jul; 27 (7): 575–582

    PubMed  CAS  Google Scholar 

  13. Bonastre J, Le Pen C, Soubrane G, et al. The burden of age-related macular degeneration: results of a cohort study in two French referral centres. Pharmacoeconomics 2003; 21 (3): 181–190

    Article  PubMed  Google Scholar 

  14. Garattini L, Castelnuovo E, Lanzetta P, 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 2004; 5 (1): 22–27

    Article  PubMed  Google Scholar 

  15. Legood R, Scuffham P, Cryer C. Are we blind to injuries in the visually impaired? A review of the literature. Inj Prev 2002 Jun; 8 (2): 155–160

    Article  PubMed  CAS  Google Scholar 

  16. Morse AR, Yatzkan E, Berberich B, et al. Acute care hospital utilization by patients with visual impairment. Arch Ophthalmol 1999 Jul; 117 (7): 943–949

    Article  PubMed  CAS  Google Scholar 

  17. Dilts DM, Khamalah J, Plotkin A. Clinical low vision resource usage prediction. Optom Vis Sci 1994 Jul; 71 (7): 422–436

    Article  PubMed  CAS  Google Scholar 

  18. McIlwaine GG, Bell JA, Dutton GN. Low vision aids: is our service cost effective? Eye 1991; 5: 607–611

    Article  PubMed  Google Scholar 

  19. Brody BL, Williams RA, Thomas RG, et al. Age-related macular degeneration: a randomized clinical trial of a self-management intervention. Ann Behav Med 1999 Fall; 21 (4): 322–329

    Article  PubMed  CAS  Google Scholar 

  20. Schmier JK, Halpern MT, Covert D, et al. Impact of visual impairment on service and support use by individuals with age-related macular degeneration [poster]. Joint Meeting of the American Academy of Ophthalmology and the Europrean Society of Ophthalmology; 2004 Oct 23–26; New Orleans (LA)

    Google Scholar 

  21. Dorfman LT, Holmes CA, Berlin KL. Service utilization by wife caregivers of frail older veterans. Soc Work Health Care 1997; 26 (2): 33–52

    Article  PubMed  CAS  Google Scholar 

  22. Moore MJ, Thu CW, Clipp EC. Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study. J Gerontol B Psychol Sci Soc Sci 2001 Jul; 56 (4): S219–S228

    Article  PubMed  CAS  Google Scholar 

  23. Aditya BS, Sharma JC, Allen SC, et al. Predictors of a nursing home placement from a non-acute geriatric hospital. Clin Rehabil 2003 Feb; 17 (1): 108–113

    Article  PubMed  CAS  Google Scholar 

  24. Wang JJ, Foran S, Smith W, et al. Risk of age-related macular degeneration in eyes with macular drusen or hyperpigmentation: the Blue Mountains Eye Study cohort. Arch Ophthalmol 2003 May; 121 (5): 658–663

    Article  PubMed  Google Scholar 

  25. Marx MS, Werner P, Cohen-Mansfield J, et al. The relationship between low vision and performance of activities of daily living in nursing home residents. J Am Geriatr Soc 1992 Oct; 40 (10): 1018–1020

    PubMed  CAS  Google Scholar 

  26. Park W. Vision rehabilitation for age-related macular degeneration. Int Ophthalmol Clin 1999 Fall; 39 (4): 143–162

    Article  PubMed  CAS  Google Scholar 

  27. Kleinman L, Schmier J, Rothman M, et al. Time and costs of managing specific disruptive behaviors in long-term care facilities: a descriptive study. The Consultant Pharmacist 2002; 17: 497–507

    Google Scholar 

  28. Brown GC, Sharma S, Brown MM, et al. Utility values and agerelated macular degeneration. Arch Ophthalmol 2000 Jan; 118 (1), 47–51

    Article  PubMed  CAS  Google Scholar 

  29. Brown GC. Vision and quality-of-life. Trans Am Ophthalmol Soc 1999; 97: 473–511

    PubMed  CAS  Google Scholar 

  30. Sharma S, Brown GC, Brown MM, et al. Converting visual acuity to utilities. Can J Ophthalmol 2000 Aug; 35 (5): 267–272

    PubMed  CAS  Google Scholar 

  31. Hopley C, Salkeld G, Wang JJ, et al. Cost utility of screening and treatment for early age related macular degeneration with zinc and antioxidants. Br J Ophthalmol 2004 Apr; 88 (4): 450–454

    Article  PubMed  CAS  Google Scholar 

  32. Trevithick J, Massel D, Robertson JM, et al. Model study of AREDS antioxidant supplementation of AMD compared to Visudyne: a dominant strategy? Ophthalmic Fpidemiol 2004 Dec; 11 (5): 337–346

    Article  Google Scholar 

  33. Busbee BG, Brown MM, Brown GC, et al. CME review: a cost-utility analysis of laser photocoagulation for extrafoveal choroidal neovascularization. Retina 2003 Jun; 23 (3): 279–287

    Article  PubMed  Google Scholar 

  34. Brown GC, Brown MM, Sharma S, et al. Incremental cost effectiveness of laser photocoagulation for subfoveal choroidal neovascularization. Ophthalmology 2000 Jul; 107 (7): 1374–1380

    Article  PubMed  CAS  Google Scholar 

  35. Hopley C, Salkeld G, Mitchell P. Cost utility of photodynamic therapy for predominantly classic neovascular age related macular degeneration. Br J Ophthalmol 2004 Aug; 88 (8): 982–987

    Article  PubMed  CAS  Google Scholar 

  36. Meads C, Salas C, Roberts T, et al. Clinical effectiveness and cost-utility of photodynamic therapy for wet age-related macular degeneration: a systematic review and economic evaluation. Health Technol Assess 2003; 7 (9): v–vi, 1–98

    PubMed  CAS  Google Scholar 

  37. Meads C, Moore D. The clinical effectiveness and cost utility of photodynamic therapy for age-related macular degeneration. Report number 24. Birmingham: West Midlands Health Technology Assessment Collaboration, Department of Public Health & Epidemiology, University of Birmingham, 2001 Nov

    Google Scholar 

  38. Smith DH, Fenn P, Drummond M. Cost effectiveness of photodynamic therapy with verteporfin for age related macular degeneration: the UK case. Br J Ophthalmol 2004 Sep; 88 (9): 1107–1112

    Article  PubMed  CAS  Google Scholar 

  39. Foran S, Wang JJ, Mitchell P. Causes of incident visual impairment: the Blue Mountains Eye Study. Arch Ophthalmol 2002 May; 120 (5): 613–619

    PubMed  Google Scholar 

  40. Kahn HA, Leibowitz HM, Ganley JP, et al. The Framingham Eye Study. I. Outline and major prevalence findings. Am J Epidemiol 1977 Jul; 106 (1): 17–32

    PubMed  CAS  Google Scholar 

  41. Klein R, Klein BE, Jensen SC, et al. The five-year incidence and progression of age-related maculopathy: the Beaver Dam Eye Study. Ophthalmology 1997 Jan; 104 (1): 7–21

    PubMed  CAS  Google Scholar 

  42. American Academy of Ophthalmology Retina Panel. Preferred Practice Patterns Committee. Age-related macular degeneration [online]. Available from URL: http://www.guideline.gov/summary/summary.aspx?.view_id=1&doc_id=4349 [Accessed 2004 Oct]

  43. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration: updated findings from two clinical trials. Arch Ophthalmol 1993 Sep; 111 (9): 1200–1209

    Article  Google Scholar 

  44. Rechtman E, Ciulla T A, Criswell MH, et al. An update on photodynamic therapy in age-related macular degeneration. Expert Opin Pharmacother 2002 Jul; 3 (7): 931–938

    Article  PubMed  CAS  Google Scholar 

  45. Sharma S, Brown GC, Brown MM, et al. The cost-effectiveness of photodynamic therapy for fellow eyes with subfoveal choroidal neovascularization secondary to age-related macular degeneration. Ophthalmology 2001 Nov; 108 (11): 2051–2059

    Article  PubMed  CAS  Google Scholar 

  46. Greiner RA. Cost of care for patients with age-related macular degeneration in Switzerland and cost-effectiveness of treatment with verteporfin therapy. Semin Ophthalmol 2001 Dec; 16 (4): 218–222

    Article  PubMed  CAS  Google Scholar 

  47. Treatment of Age-related macular degeneration with Photodynamic therapy (TAP) Study Group. Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: one-year results of 2 randomized clinical trials. TAP report. Arch Ophthalmol 1999 Oct; 117 (10): 1329–1345

    Google Scholar 

  48. Hart PM, Chakravarthy U, Stevenson MR, et al. A vision specific functional index for use in patients with age related macular degeneration. Br J Ophthalmol Oct 1999; 83 (10): 1115–1120

    Article  CAS  Google Scholar 

  49. Churchill AJ, Franks WA, Ash DV. An alternative and more cost effective method of delivery of radiotherapy in age related macular degeneration. Br J Ophthalmol 1998 Apr; 82 (4): 373–375

    Article  PubMed  CAS  Google Scholar 

  50. Goodrich GL, Kirby J. A comparison of patient reading performance and preference: optical devices, handheld CCTV (Innoventions Magni-Cam), or stand-mounted CCTV (Optelec Clearview or TSI Genie). Optometry 2001 Aug; 72 (8): 519–528

    PubMed  CAS  Google Scholar 

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Acknowledgements

No funding was received for the preparation of this review and the authors are not currently receiving any funding directly related to the contents of the review.

The authors have no conflicts of interest that are directly relevant to the content of this review.

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Correspondence to Michael T. Halpern.

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Schmier, J.K., Jones, M.L. & Halpern, M.T. The Burden of Age-Related Macular Degeneration. Pharmacoeconomics 24, 319–334 (2006). https://doi.org/10.2165/00019053-200624040-00003

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