Findings of this Report versus the 2007 PBA Estimate
Costs for specific categories from the current and prior PBA estimate are listed in Table 18.1. Our cost estimates for specific conditions are generally much higher than in the previous estimate. This is due primarily to the different data and methodology we employ; using survey data on all costs will capture costs paid by vision insurance plans, costs paid out of pocket, and prescription drug costs which were not captured in the earlier report. Our econometric approach also will identify non-eye care costs that can be attributed to eye and vision disorders. These differences account for an addition of $14.2 billion in the current estimate. Frick et al 2007 found higher costs due to low vision than are reported in the current report, this apparent reduction is due to us controlling for the presence of a diagnosed disorder. We also capture medical costs for ages younger than age 40, which adds another $13.2 billion.
We find productivity losses to by $40.4 billion higher than in the 2007 estimate ($48.4bn versus $8bn), but most of this difference can be attributed to the assumption by Rein et al that productivity losses accrue only in the age 40-64 group. When looking only at this age group, we find productivity losses only $2.8 billion higher ($10.8 billion total) than Rein et al., a difference entirely attributable to increases in wages and population growth.
Our estimate of nursing home costs nearly doubles that found by Rein et al, but almost all of this difference is attributable to us using a higher estimated cost of long term care, and also the inclusion of skilled nursing facilities in the current estimate.
We also find higher costs of informal care. We add informal care costs for children which was not included in the 2007 report. The increase in informal care costs for adults is primarily due to our assumption of valuing informal care hours based on the U.S. average wage, versus the then U.S. minimum wage employed by Frick et al (2007).
An additional $5.3 billion of the increase in the estimate occurs among other direct and indirect costs, primarily due to the inclusion of additional costs such as aids and devices, special education, and entitlement programs.
The 2007 PBA report included $10.5 billion in monetized quality of life losses, based on an assumed value of $50,000 per QALY. We do not include monetized quality of life in the primary economic burden results. If we had assumed $50,000 per DALY, our estimated burden would be $14.1 billion. If we had instead used QALYs, the monetary cost at $50,000 per QALY would be $30 billion. This increase from the $10.5 billion found by Frick et al is due to methodological differences.