Burden of illness of neovascular age-related macular degeneration in Canada

doi:10.3129/i07-153

Canadian Journal of Ophthalmology

Volume 42, Issue 6, December 2007, Pages 836-843

https://doi.org/10.3129/i07-153 Get rights and content

Abstract

Background: Age-related macular degeneration (AMD) is a retinal disease affecting more than 2 million Canadians over the age of 50. The neovascular form of AMD is responsible for 90% of severe vision loss associated with the disease. This study was conducted to assess the burden of neovascular AMD in the Canadian population.

Methods: A cross-sectional, observational study was conducted of self-reported functional health, well-being, and disease burden among elderly subjects in Canada with (n = 67) and without (n = 99) neovascular AMD. Subjects completed telephone surveys of the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25),the EuroQol questionnaire (EQ-5D), and the Hospital Anxiety and Depression Scale (HADS). Subjects also reported their history of falls and fractures and annual health care resource utilization.

Results: Subjects with neovascular AMD reported significantly worse vision-related functioning and overall well-being than controls (adjusted mean scores on the NEI-VFQ-25:48.0 vs. 87.5; p < 0.0001) and significantly more depression symptoms than controls (HADS depression: 5.8 vs. 4.3; p = 0.037). Subjects with neovascular AMD also reported more than twice the need for assistance with daily activities compared with controls (19.4% vs. 9.1%; p = 0.013) and a nearly 3 times higher fall rate than the control group (22.4% vs. 8.1%; p = 0.014).The annual neovascular AMD cost per patient was Can$11334, which is over 8 times that of elderly subjects without neovascular AMD (Can$1412). Over half of the neovascular AMD costs were direct medical costs.

Interpretation: Neovascular AMD is associated with significant limitation in functional abilities and quality of life, resulting in increased health care resource utilization and high patient support costs. These findings emphasize the need for new treatments for neovascular AMD that will prevent vision loss and progression to blindness in order to lessen the ensuing economic burden.

Résumé

Contexte: La dégénérescence maculaire liée à l’âge (DMLA) est une maladie rétinienne qui affecte plus de 2 millions de Canadiens de plus de 50 ans. La forme néovasculaire de la DMLA est responsable de 90 % des pertes de vision graves associées à la maladie. Cette étude a donc pour objet d’évaluer le fardeau de la DMLA néovasculaire chez la population canadienne.

Méthodes: Une étude transversale basée sur l’observation a été menée sur la santé fonctionnelle, le bien-être et le fardeau de la maladie dont ont fait état des personnes aînées du Canada atteintes (n = 67) et non atteintes (n = 99) de DMLA néovasculaire. Les sujets ont répondu par sondages téléphoniques au questionnaire du National Eye Institute sur la fonction visuelle (NEI-VFQ-25), à celui d’EuroQol (EQ-5D) et à l’échelle HAD (sur les troubles d’anxiété et de dépression des personnes hospitalisées — HADS). Ils ont aussi fait état de leurs chutes et fractures ainsi que de leur consultation annuelle des centres de soins.

Résultats: Les sujets atteints de DMLA néovasculaire ont fait état d’un fonctionnement lié à la vue et d’un bien-être général significativement inférieurs à ceux du groupe témoin (moyenne des résultats du NEI-VFQ-25 après rajustement: 48,0 vs 87,5; p < 0,0001) et signalé significativement plus de symptômes de dépression que le groupe témoin (résultats HADS: 5,8 vs 4,3; p = 0,037). Les sujets atteints de DMLA ont aussi indiqué qu'ils avaient davantage besoin d’aide pour les activités quotidiennes que ceux du groupe témoin (19,4% vs 9,1%; p = 0,013) et montré un taux de chute près de 3 fois plus élevé que celui du groupe témoin (22,4 % vs 8,1%; p = 0,014). Les coûts annuels de la DMLA ont été de 11334 $ CAN par patient, soit 8 fois plus que chez les sujets âgés sans DMLA (1412 $ CAN). Plus de la moitié des coûts de la DMLA néovasculaire ont été des frais médicaux directs.

Interprétation: La DMLA néovasculaire est associée avec une limitation significative de la capacité de fonctionnement et de la qualité de vie, entraînant un recours accru aux services de santé et des frais élevés de soutien auprès des patients. Ces résultats mettent l’accent sur le besoin de nouveaux traitements pour la DMLA, qui préviendront la perte de vision et la progression vers la cécité afin de réduire le fardeau économique qui s'ensuit.

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This nationwide population-based cohort study used authorized clinical data provided by the Korean National Health Insurance Service.
A total of 3 599 589 individuals older than 50 years participated in the Korean National Health Screening Program in 2009.
Age-related macular degeneration diagnosis and the presence of accompanying VD were verified using diagnostic codes and disability registration data. Data on covariates, including age, sex, income level, residential area, systemic comorbidities, and behavioral factors, were collected from health screening results and claims data. Patients were followed up until December 2019, and incident cases of depression were identified using registered diagnostic codes. The prospective association of AMD and related VD with new-onset depression was investigated using the multivariable-adjusted Cox proportional hazard model.
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During an average follow-up period of 8.52 years, 1 037 088 patients received new diagnoses of depression. Patients with previous diagnoses of AMD showed a greater risk of new-onset depression, with a hazard ratio of 1.15 (95% CI, 1.13–1.17) compared with the control group in the fully adjusted model. Patients with AMD and accompanying VD showed a further increased risk of depression, with a hazard ratio of 1.23 (95% CI, 1.16–1.30).
Individuals with a diagnosis of AMD have a higher risk of depression developing in the future. The risk of depression is increased further in patients with AMD who demonstrate VD.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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The economics of vision impairment and its leading causes: A systematic review
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Vision impairment (VI) can have wide ranging economic impact on individuals, households, and health systems. The aim of this systematic review was to describe and summarise the costs associated with VI and its major causes. We searched MEDLINE (16 November 2019), National Health Service Economic Evaluation Database, the Database of Abstracts of Reviews of Effects and the Health Technology Assessment database (12 December 2019) for partial or full economic evaluation studies, published between 1 January 2000 and the search dates, reporting cost data for participants with VI due to an unspecified cause or one of the seven leading causes globally: cataract, uncorrected refractive error, diabetic retinopathy, glaucoma, age-related macular degeneration, corneal opacity, trachoma. The search was repeated on 20 January 2022 to identify studies published since our initial search. Included studies were quality appraised using the British Medical Journal Checklist for economic submissions adapted for cost of illness studies. Results were synthesized in a structured narrative. Of the 138 included studies, 38 reported cost estimates for VI due to an unspecified cause and 100 reported costs for one of the leading causes. These 138 studies provided 155 regional cost estimates. Fourteen studies reported global data; 103/155 (66%) regional estimates were from high-income countries. Costs were most commonly reported using a societal (n = 48) or healthcare system perspective (n = 25). Most studies included only a limited number of cost components. Large variations in methodology and reporting across studies meant cost estimates varied considerably. The average quality assessment score was 78% (range 35–100%); the most common weaknesses were the lack of sensitivity analysis and insufficient disaggregation of costs. There was substantial variation across studies in average treatment costs per patient for most conditions, including refractive error correction (range $12–$201 ppp), cataract surgery (range $54–$3654 ppp), glaucoma (range $351–$1354 ppp) and AMD (range $2209–$7524 ppp). Future cost estimates of the economic burden of VI and its major causes will be improved by the development and adoption of a reference case for eye health. This could then be used in regular studies, particularly in countries with data gaps, including low- and middle-income countries in Asia, Eastern Europe, Oceania, Latin America and sub-Saharan Africa.
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We enrolled 186,591 patients who underwent cataract surgery in both eyes between 2008 and 2013 and monitored them from the index date (the date of first cataract surgery) until AMD, death, loss to follow-up, or December 31, 2017, whichever occurred first. Propensity score matching (PSM) was used to balance the baseline characteristics between the BF-IOL and non–BF-IOL groups.
BF-IOLs were implanted in 21,126 patients (11.3%) and non–BF-IOLs were implanted in 165,465 patients (88.7%). Patients in the BF-IOL group tended to be younger, with fewer men, different cataract surgery years, higher income, more nonmanual workers, more patients from urban and suburban areas, and fewer chronic diseases compared with the non–BF-IOL group. With a mean follow-up period of 6.1 years (range, 1-10 years) after cataract surgery, 12,533 and 1655 patients developed non-exudative AMD and exudative AMD, respectively. The incidence rate of non-exudative AMD and exudative AMD (per 1000 person-years) was 9.95 and 1.22 for the BF-IOL group and 11.13 and 1.44 for the non–BF-IOL group, respectively. After PSM, no statistical difference in the incidence rate of nonexudative AMD (hazards ratio, 0.95; 95% CI, 0.88-1.03) and exudative AMD (hazard ratio, 0.96; 95% CI, 0.77-1.18) was observed between the BF-IOL and non–BF-IOL groups.
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Patients who underwent uneventful cataract surgery between 2007 and 2018 at the Ophthalmology Unit of Kymenlaakso Central Hospital, Kotka, Finland.
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Neovascular age-related macular degeneration-free survival.
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In a large cohort of patients who underwent cataract surgery, the use of a BLF IOL resulted in no apparent advantage over a non-BLF IOL in the incidence of nAMD or its progression, nor in clinical variables related to nAMD severity.

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Burden of illness of neovascular age-related macular degeneration in Canadaa

Abstract

Résumé

Ophthalmology

Surv Ophthalmol

Can J Ophthalmol

Value Health

Can J Ophthalmol

Arch Gerontol Geriatr

Magnitude and causes of visual impairment

Fact sheet 282

The burden of age-related macular degeneration: results of a cohort study in two French referral centres

Pharmacoeconomics

Measurement of the economic impact of visual impairment from age-related macular degeneration in Australia

Clin Experiment Ophthalmol

A vision specific functional index for use in patients with age related macular degeneration

Br J Ophthalmol

The psychosocial impact of macular degeneration

Arch Ophthalmol

Impact of bilateral visual impairment on health-related quality of life: the Blue Mountains Eye Study

Invest OphthalmolVis Sci