Economic burden of late-stage age-related macular degeneration

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European and Canadian researchers joined forces to determine the economic burden of late-stage age-related macular degeneration (AMD) in Bulgaria, Germany, and the US. Nabin Paudel, PhD, the study’s first author from Retina International, Dublin, Ireland, and colleagues described the results of this economic evaluation study, with reduced well-being and loss of productivity large contributors to the total economic burden.¹

AMD can be associated with adverse economic outcomes^2-5 that can extend beyond the direct medical costs associated with treatment. “People living with AMD often require additional support, including caregiving services, vision aids, and rehabilitation, further escalating the economic burden. The association of AMD with an individual’s and caregiver’s emotional well-being and productivity remains poorly understood,” the investigators commented.⁶

The study under discussion considered the economic disease burden on both the patient and the caregivers, the first such study of its kind.

“Understanding the comprehensive economic burden of AMD could aid with decision-making in health care policy, economic planning, health technology assessments, medical research, and public health initiatives, potentially leading to better health outcomes and more efficient use of resources,” Paudel and colleagues explained.

Prevalence approach cost-of-illness economic modeling

The authors chose this approach to estimate costs attributable to late-stage AMD. They obtained data by primary data collection and from the literature from January 2021 to March 2022.

Patients over 50 years of age in Bulgaria, Germany, and the US who had late-stage AMD (neovascular AMD or any form of geographic atrophy [GA]) in one or both eyes and caregivers who cared for patients diagnosed with late-stage AMD were recruited through ophthalmologic clinics. Recruitment in Bulgaria and Germany was via online newsletters and through social media in the US, the investigators described.

The main outcomes were the direct disease-related health care expenditures, indirect medical costs such as care support and assistive technology, well-being cost (loss of well-being), and productivity cost (loss of productivity due to the disease for patients and caregivers).

Economic findings

A total of 128 patients (80 women) with late-stage AMD were included; 120 patients (94%) were aged 60 years or older. Sixty-one caregivers (43 women) were included, of whom 55 were 45 years or older.

The main findings in the study were as follows. “The estimated per-annum total costs attributable to late-stage AMD were €449.5 million ($512.5 million) in Bulgaria, €7.6 billion ($8.6 billion) in Germany, and €43.2 billion ($49.4 billion) in the US. Across all countries, 10% to 13% of the total cost incurred was attributed to direct medical costs. In Germany and Bulgaria, the biggest contributor to the total economic burden was reduced well-being (67% and 76%, respectively); in the US, loss of productivity (42%) was the biggest contributor,” Paudel and colleagues reported.

The study findings showed the substantial burden of late-stage AMD on patients and caregivers in the areas surveyed. “Across the 3 countries, reduced well-being and loss of productivity were relatively large contributors to the total economic burden. Direct medical costs contributed to a relatively small portion of the total cost. Implementing measures to reduce the AMD incidence, delay disease progression, and alleviate humanistic burden may help reduce the economic burden of late-stage AMD.

“These findings suggest an urgent need to identify strategies to minimize the costs and impact for patients, caregivers, and society. Raising awareness and improving early detection and access to vision rehabilitation services could help mitigate some of the indirect costs imposed by vision loss due to late-stage AMD. Access to current and future therapies for late-stage AMD, including both neovascular AMD and GA, holds promise for reducing the projected increase in AMD burden amid global aging populations,” the authors concluded.

References

1. Paudel N, Brady L, Stratieva P, et al. Economic burden of late-stage age-related macular degeneration in Bulgaria, Germany, and the US. JAMA Ophthalmol. 2024;142:1123-1130. doi:10.1001/jamaophthalmol.2024.4401

2. Ke KM, Chakravarthy U, O’Neill C. Economic cost of age-related macular degeneration: a review of recent research. Drugs Aging. 2006;23:217-225. doi:10.2165/00002512-200623030-00004

3. Bonastre J, Le Pen C, Anderson P, Ganz A, Berto P, Berdeaux G. The epidemiology, economics and quality of life burden of age-related macular degeneration in France, Germany, Italy and the United Kingdom. Eur J Health Econ. 2002;3:94-102. doi:10.1007/s10198-002-0104-y

4. Brown MM, Brown GC, Stein JD, Roth Z, Campanella J, Beauchamp GR. Age-related macular degeneration: economic burden and value-based medicine analysis. Can J Ophthalmol. 2005;40:277-287. doi:10.1016/S0008-4182(05)80070-5

5. Sarda SP, Heyes A, Bektas M, et al. Humanistic and economic burden of geographic atrophy: a systematic literature review. Clin Ophthalmol. 2021;15:4629-4644. doi:10.2147/OPTH.S338253

6. Weyer-Wendl H, Walter P. Financial burden and quality of life of informal caregivers of patients with wet age-related macular degeneration. Health Econ Rev. 2016;6:37. doi:10.1186/s13561-016-0116-4