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Editors Selection IGR 11-4

Health Economics: Epidemiology and the economic and individual burdens of glaucoma

Comment by George Lambrou on:

48360 An assessment of the health and economic burdens of glaucoma, Varma R; Lee PP; Goldberg I et al., American Journal of Ophthalmology, 2011; 152: 515-522

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After the initial 2006 (frequently quoted since) and the awareness campaigns of recent years, it is a commonly shared knowledge that glaucomas are the second leading cause of blindness worldwide and one of the principal causes of preventable vision loss. But ‐ beyond being able to correctly rank glaucoma among the major 'thieves of sight' what do we know about the financial and quality-of-life impact of this spectrum of diseases on patients, health systems and societies in general?

This is what Varma et al. (2162) set out to chart in their review article, aiming to integrate data from epidemiologic, health-economic and individual-burden papers published between 1991 and 2010. The epidemiological data are stunning: prevalence is steadily increasing as the population ages; an estimated 3% of the global population aged 40+ has glaucoma, more than half of the cases being undiagnosed and therefore at risk of going blind; the global increase in prevalence will affect both developed and developing countries. The financial burden to society is significant and increases with disease severity: the combined direct treatment costs range from € 400-500 to ca. AUS$ 2500 p.a. depending on stage of disease (average of all stages: AUS$ 1800). Of note, these figures do not include indirect costs (like rehabilitation, costs to families, home assistance, etc.) which are highly variable between studies and geographies, ranging, e.g., between € 12000 and 19000/y in selected European countries. The recent publication of guidelines for calculating the economic burden of visual impairment should facilitate the consistent evaluation of such costs.

Finally ‐ and most importantly ‐ the patients' quality-of-life is impacted from the very early stages of glaucoma, even if one eye only is affected, and this impact increases with disease severity, mainly with visual field loss. This impact is related to degradation or loss of reading, mobility or driving abilities, to the increased risk of motor or domestic accidents, as well as to a heavier psychological burden to patients and families alike, possibly leading to depression. It is important to note that whereas the financial burden of glaucoma is exclusively related to diagnosed cases, the QoL burden extends to diagnosed and undiagnosed patients alike.

Awareness of the relatively low cost of avoiding the individual and social burden of the disease, may give glaucoma prevention the priority it deserves

While the publication highlights the growing global cost and societal burden of the disease, it also carries the seed of hope: blindness from glaucoma is preventable and the progression of visual impairment can be slowed down significantly by early diagnosis and adequate treatment. The authors cite an Australian estimation that implementing the Vision 2020 intervention package would cost approximately AUS$ 5600/QALY ‐ an extremely cost-effective intervention if compared to current NICE guidelines placing the bar of acceptable cost-effectiveness (i.e., what society 'should be willing to pay to improve the QoL of its members') at £ 30000/QALY. It is up to the glaucoma community, by increasing awareness of physicians, policymakers and the public to the burden of glaucoma and the relatively low cost of avoidance of this burden, to give glaucoma prevention the priority rank it deserves.

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