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DISCLAIMER:
These materials were prepared by subcontractors for consideration
by the Committee on Public Health Approaches to Reduce Vision
Impairment and Promote Eye Health. The responsibility for the
content of this article rests with the author and does not necessarily
represent the views of the National Academies of Sciences,
Engineering, and Medicine or its committees and convening bodies.
These analyses were commissioned and overseen by the Committee,
but are not incorporated as a whole in the Committee¡¯s final report.
Neither the methodology nor the subcontractor reports have been
subject to formal institutional review.
The Future of Vision
The Preventable Burden of
Untreated Eye Disorders
FINAL REPORT
PRESENTED TO:
JULY 16, 2016
Meg McCoy
The National Academy of Sciences,
Engineering, and Medicine
500 Fifth Street, NW, Room 857
Washington, DC 20001
PRESENTED BY:
John Wittenborn
David Rein
NORC at the
University of Chicago
55 East Monroe Street
30th Floor
Chicago, IL 60603
(312) 759-4000
(312) 759-4004
FINAL REPORT
| The Preventable Burden of Untreated Eye Disorders
Contents
1.
Executive Summary ........................................................................................................ 10
2.
Methods ........................................................................................................................... 13
Overview of Approach ....................................................................................................... 13
Data Sources .................................................................................................................... 14
Vision Problems in the U.S. (VPUS) - ........................... 14
National Health and Nutrition Examination Survey (NHANES) ................................. 14
Cost of Vision Problems - costofvision. ................................... 15
Approach for Calculating Uncorrected Refractive Error ...................................................... 19
Overview of Approach ....................................................................................................... 19
Step 1. Identify the prevalence rate of URE ............................................................. 19
Step 2. Calculate Prevalent Population with URE .................................................... 21
Step 3. Estimate cost and impact of treatment ......................................................... 21
Approach for Calculating Eye Diseases ................................................................................ 22
Overview of Approach ....................................................................................................... 22
Step 1. Estimate undiagnosed prevalence rates for each disease ........................... 22
Step 2. Allocating blindness and visual impairment by condition .............................. 24
Step 3. Estimate current and predicted future undiagnosed prevalence of each
disease, including the resulting number impaired and blind .......................... 26
Step 4. Apply a treatment efficacy estimate to estimate the potential benefits of
identification and treatment .......................................................................... 26
Step 5. Apply costs of treatment, and cost offsets of avoided impairment and
blindness ...................................................................................................... 28
Adjusting Costs for Inflation and Cost Growth ..................................................................... 29
Real and Nominal Costs .......................................................................................... 29
Nominal cost inflators .............................................................................................. 29
Real medical cost inflators ....................................................................................... 29
Discounting .............................................................................................................. 30
Results ..................................................................................................................................... 31
Uncorrected Refractive Error ............................................................................................ 31
Prevalence .............................................................................................................. 31
Impact on Costs ....................................................................................................... 33
Impact on QALYs..................................................................................................... 36
Age-related Macular Degeneration ¨C Choroidal Neovascularization .................................. 37
FINAL REPORT | 2
FINAL REPORT
| The Preventable Burden of Untreated Eye Disorders
Prevalence .............................................................................................................. 37
Diagnosis Rate ........................................................................................................ 39
Treatment ................................................................................................................ 40
Impact on Costs ....................................................................................................... 43
Impact on QALYs..................................................................................................... 44
AMD ¨C Geographic Atrophy .............................................................................................. 46
Prevalence .............................................................................................................. 46
Diagnosis Rate ........................................................................................................ 49
Proportion of GA Patients with Vision Loss .............................................................. 49
Treatment ................................................................................................................ 50
Impact on Costs ....................................................................................................... 51
Impact on QALYs..................................................................................................... 54
Cataract ............................................................................................................................ 55
Prevalence .............................................................................................................. 55
Diagnosis Rate ........................................................................................................ 58
Vision Loss Attributable to Cataract ......................................................................... 59
Treatment ................................................................................................................ 59
Impact on Costs ....................................................................................................... 61
Impact on QALYs..................................................................................................... 63
Glaucoma ......................................................................................................................... 64
Prevalence .............................................................................................................. 64
Diagnosis Rate ........................................................................................................ 67
Vision Loss Attributable to Glaucoma ...................................................................... 68
Treatment ................................................................................................................ 68
Impact on Costs ....................................................................................................... 70
Impact on QALYs..................................................................................................... 73
Diabetic Retinopathy ......................................................................................................... 74
Prevalence .............................................................................................................. 74
Diagnosis Rate ........................................................................................................ 77
Proportion of DR Patients with Vision Loss .............................................................. 78
Treatment for DR ..................................................................................................... 78
Prevalence of Vision Loss with and Without Treatment............................................ 80
Impact on Costs ....................................................................................................... 81
Impact on QALYs..................................................................................................... 83
Prevalence .............................................................................................................. 85
Diagnosis Rates ...................................................................................................... 87
Undiagnosed/Untreated Prevalence ........................................................................ 88
Vision Loss from Treatment ..................................................................................... 90
Impact on Costs ....................................................................................................... 91
Impact on QALYs..................................................................................................... 93
FINAL REPORT | 3
FINAL REPORT
| The Preventable Burden of Untreated Eye Disorders
Per-person Results ................................................................................................................. 96
Prevalence of Eye Disorders Per-person ................................................................. 96
Prevalence of Vision Loss Per-person ..................................................................... 99
Impact of Treatment on Vision Loss Prevalence .................................................... 101
Per-person Net Costs and QALY Impacts from Treatment..................................... 102
Sensitivity Analysis .............................................................................................................. 105
Description of Parameter Group Variation ....................................................................... 105
Summary Results of Sensitivity Analysis ......................................................................... 119
CNV Treatment Sensitivity ..................................................................................... 120
Cataract Treatment Sensitivity ............................................................................... 121
Glaucoma Treatment Sensitivity ............................................................................ 122
DR Treatment Sensitivity ....................................................................................... 123
URE Treatment Sensitivity ..................................................................................... 124
Limitations and Major Assumptions .................................................................................... 125
Data limitations ............................................................................................................... 125
Methodological limitations and major assumptions.......................................................... 126
Limits of the knowledge claim ......................................................................................... 128
Addressing Data Limitations and the Need for Vision and Eye Health Surveillance ....... 130
Introduction ..................................................................................................................... 130
Limits of Current Evidence .............................................................................................. 130
Requirements for a national vision and eye health surveillance system .......................... 132
Unique Challenges posed by Vision and Eye Health ....................................................... 132
Complex and Difficult to Measure Outcomes ......................................................... 133
Broad Range of Included Conditions ..................................................................... 133
High Undiagnosed Prevalence............................................................................... 133
Separation of Eye Care among Multiple Health and Payment Systems ................. 133
Building a Comprehensive Vision and Eye Health Surveillance System.......................... 134
Selecting Conditions and Measures ....................................................................... 134
Identifying and selecting data sources ................................................................... 134
Developing National Surveillance Estimates .......................................................... 138
Conclusion ............................................................................................................................ 140
References ............................................................................................................................ 142
FINAL REPORT | 4
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