Low Vision Adaptations and Devices
As part of the 1999 French census, the Institut National de la Statistique et des Etudes Economiques conducted the Handicap Incapacity Dependency (HID) and Everyday Life and Health (ELH) surveys. These nationally representative surveys included 18 items that were used to assess the self-reported level of disability of more than 359,000 respondents of all ages. Using these data, Brézin et al. categorized respondents into four categories of visual impairment, ranging from blind to no visual problems.[28, 29] These data were controlled for age, number of handicaps, and size of household to calculate the extent to which blindness and low vision necessitated the purchase of assistive devices, such as walking aids and computer software. Brézin et al. also estimated the cost of home adaptations; however, because most of these adaptations focus on wheelchair access for the elderly, we did not include these costs in this analysis.
Using these differential usage rates for blind and visually impaired individuals and applying similar methods to other national registers, Lafuma et al. estimated direct nonmedical costs attributable to visual impairment in France, Italy, Germany, and the United Kingdom based on the prevalence of blindness and low vision as well as the unit costs of home adaptations and assistive devices in each of these four countries depreciated over 3 years.[30, 31] Lafuma et al. estimate that the non-institutionalized visually impaired and blind in these four countries spent on average an additional €536 on assistive devices relative to the general population in 2004. We assume the relative demand for assistive devices by persons with low vision in the United States is similar to the demand for these devices in Europe. Home adaptations included in the analysis focused on handicap accessibility and elderly care, and thus we exclude these costs while focusing on the younger population. We also excluded wheelchairs and the cost of guide dogs, which has been previously studied in the United States. We estimated U.S. market costs for white sticks and audio players based on the average February 2012 costs for all category items at MaxiAids.com, a large online retailer of low vision assistance devices. The assistive devices in Lafuma et al. included three baskets of goods that were not individually described (optical assistance devices, computer interface devices, and software). We were unable to identify U.S. market costs for these items. We converted the unit costs reported by Lafuma et al. to U.S. dollars using the 2004 average exchange rate and then inflated them to 2013 dollars based on the Consumer Price Index. We then used our estimates of the prevalence of blindness and visual impairment in the United States to derive U.S., age-specific differential usage rates and applied these to the average unit costs to determine the per capita costs of these devices. Estimated annual costs per individual with low vision and overall costs per assistive device are shown in Table 9.1.
Table 9.1. Cost of Assistive Devices for the Visually Impaired, per Individual
Dog Guides for the Blind
We based the cost of dog guides on the findings of a cost-benefit analysis that surveyed 10 of the 12 major guide dog training schools in the United States. Training guide dogs entails costs associated with breeding, veterinary expenses, and staff. Recipients of guide dogs also travel to the school for training prior to placement of the dog. The majority of these costs are covered by charitable donations, allowing blind individuals to obtain guide dogs for free or at a substantially reduced price. In 2003, 2,015 guide dogs were provided to blind individuals, and more than 9,000 guide dogs were known to be working in the United States. The average total cost of training and providing a guide dog was $35,536. The average annual maintenance cost over a dog’s 8-year working life was $700 per year. The total cost of guide dog training and maintenance was estimated to be $62 million per year in 2004. We again assume that use of guide dogs is equally distributed across ages. We adjusted the cost of guide dogs to 2013 dollars using the Consumer Price Index, resulting in an annual burden of approximately $73 million (Table 9.3).