Conclusions

This report provides the most comprehensive and up-to-date estimate of the total economic burden of eye diseases and vision loss in the United States to date. Understanding the costs of disease provides vital information for identifying areas of need for future research and healthcare investment. This is particularly important for the areas of eye disease and vision loss, as the indirect costs of low vision greatly increase the total burden of these conditions beyond the healthcare sector. Our findings show that eye disorders and vision loss are among the costliest conditions to the U.S. economy, and based on ever-increasing healthcare costs and an aging population, this cost is set to continue to grow.

Direct Medical Costs of Major Chronic Conditions

At $139 billion, our estimated burden more than doubles the previous cost estimate. Most of this increase is related to differences in approach and methodology. In part due to controversy over which costs should be included in the estimated cost of vision problems, recent consensus guidelines have delineated and defined which costs should be included, and how they should be reported.[1] Following these guidelines, this analysis provides a more comprehensive accounting of total costs, thus leading to the apparent increase in the cost estimate. The previous PBA estimate was limited to persons aged 40 and older, this report includes the total population. The previous report only included medical costs of four diagnosed eye disorders and vision aids, while this analysis includes all disorders related to the eyes and ocular adnexa. The prior report included productivity losses only for ages 40-64, which substantially underestimates these costs to the total population. This report captures the costs of routine eye examinations and costs paid out of pocket or by vision insurance plans, much of which may not have been included in the previous estimate.

This analysis also uses different data sources and methodologies designed to capture all medical costs attributable to eye disorders whereas the prior estimate captured the medical costs of claims directly related to the medical treatment of the four included eye diseases, an approach that will provide a more robust estimate of payer costs but will not capture ancillary medical costs that can be attributed to eye disorders, for example costs from falls, depression or lower physical activity. As the first comprehensive estimate of the costs of visual disorders, that analysis intentionally took a conservative cost estimation approach with the intent of creating an estimate of the floor of costs for those ages 40 and older. Finally, this analysis is simply more recent and will therefore reflect increases in medical costs and growth of the affected population that have occurred over the course of the nine years since the 2004 baseline year of prior estimate.

The differences in the results between this analysis and the prior PBA estimate highlight the difficulties and pitfalls of comparing disparate economic burden estimates. Nonetheless, it is apparent that vision loss and eye disorders are among the costliest conditions facing the United States. Although subject to significant methodological differences, a recent analysis of the cost of seven major chronic diseases in the United States, which did not include vision, only reported four conditions with direct costs higher than our findings of $66.8 billion.[7, 8] This is in line with findings from Australia, where vision disorders are estimated to be the seventh costliest health condition.[9]

These findings underscore the fact that chronic conditions are the largest drivers of cost for healthcare in United States and will continue to be so as the confluence of rising medical costs, increased access to care, and an aging population will continue to drive growth in medical costs. Another important finding of this analysis is that government pays the majority of healthcare costs and the majority of long-term care costs. Finally, due to the debilitating nature of vision loss, indirect costs including productivity losses and long-term care actually exceed direct costs for eye and vision problems, as eye disorders and visual loss incur a large burden on the overall U.S. economy even beyond the healthcare sector.