Medical Costs by Diagnosis
We estimated the total and per-person costs of diagnosed disorders in the MEPS data file using the 2-part model with individual disorder categories as the primary independent variable. We report the summed cost of optometrist visit care and vision aid costs as the cost of “Vision Correction”, although some of this cost may include services provided by optometrists for diagnosed disorders that were not identified in the MEPS Medical Provider Component.
Total Medical Costs by Disorder, in $ millions
Click on an age-group category to highlight the data.
|Vision Disorder||Age 0-17||Age 18-39||Age 40-64||Age 65+||All ages|
|Glaucoma and optic nerve||13||124||1558||4059||5755|
|Retinal disorder, no diabetes||27||106||988||3469||4590|
|Conjunctivitis, lacrimal/eye lid||836||860||1443||1417||4556|
|Retinal disorders, with diabetes||21||59||901||3104||4086|
|Blindness and low vision||122||353||1326||1959||3760|
|Undiagnosed low vision||48||474||1702||798||3022|
|Disorders of the globe||279||451||930||773||2435|
|Injuries and burns||125||515||444||244||1329|
Table 6.2 Per-person Medical Costs by Disorder*
A major limitation of the MEPS structure is that diagnoses are tracked only at the 3-digit ICD-9 level, which means that some important conditions defined at the 4th or 5th digit are not separately identifiable. Such conditions include amblyopia, age-related macular degeneration (362.5) and diabetic retinopathy (362.0). We detail the identification of ICD-9 codes in section 3.2. We attempted to approximate the diagnoses of age-related macular degeneration and diabetic retinopathy by creating two conditions; “retinal disorder with diabetes” for persons diagnosed with retinal disorders and self-report diabetes, and “retinal disorder without diabetes” for persons with retinal disorders but do not report diabetes. We assume that this approach will approximate actual diagnoses of diabetic retinopathy and other retinal disorder including macular degeneration.
Total medical costs by disorder are listed in Table 6.1, while per-person medical costs by disorder are listed in Table 6.2. Due to limitations in the data and our approach, almost none of the cost estimates for each condition are statistically different from one another. While we list and describe the costs for each condition in order of our estimate, these results should not be construed as providing a definitive ranking of costs. In addition, due to sample size limitations, we estimated costs for each eye disorder without controlling for the presence of other eye disorders, thus double counting many costs. For the total costs, we controlled for this by deflating all costs per age group such that they summed to the overall cost estimate identified when we grouped all diagnosed disorders into a single independent variable. We did not control for such double counting when reporting per-person medical costs, thus summing costs across conditions would overstate total costs.
Our estimates for age related macular degeneration and diabetic retinopathy are likely to be overstated. Due to data limitations, we report the costs for all retinal disorders for persons with diabetes as analogous to diabetic retinopathy, and the cost for all retinal disorders without diabetes as analogous to the costs of age-related macular degeneration. While our estimated costs of AMD and diabetic retinopathy are much higher than found by Rein et al (2006), they are in line with other estimates of these costs. Day et al found per-person Medicare costs for AMD to be $3,263 per year. Based on our estimate of the treated prevalence, which may also be an overestimate, this would imply at total cost of $5.7 billion. Similarly, an analysis by Schmier et al found Medicare payments for persons with proliferative diabetic retinopathy to be $3,825 higher than controls. Based on our estimate of treated prevalence, although likely an overestimate, this would indicate a possible cost of diabetic retinopathy of $6.2 billion.