Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany.
Department of Ophthalmology, University of Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Germany.
Eur J Health Econ. 2020 Feb;21(1):115-127. doi: 10.1007/s10198-019-01115-5. Epub 2019 Sep 6.
Visual impairment and blindness cause a considerable and increasing economic burden affecting not only persons with vision loss and their families, but also societies. For the majority of countries, there is no solid database that would allow a comprehensive assessment of costs from a societal perspective. The present study was conducted to fill this gap.
To investigate resource utilization of blind or visually impaired people and to assess the economic burden of blindness and visual impairment in Germany.
This cross-sectional cost-of-illness study measures the economic burden of blindness and visual impairment bottom-up and from a societal perspective. Therefore, blind and visually impaired persons were recruited via national self-help organizations (prevalence-based approach) and interviewed regarding their utilized resources using various survey modes (mixed-mode approach). The observation period was 6 months retrospectively. Utilized resources were valued applying standardized unit costs (macro-costing). Calculations for the study population provided direct and indirect costs per person for a period of 6 months. Further cost per category was extrapolated to 1 year for the general population of Germany. Uncertainty of results was addressed applying univariate deterministic sensitivity analyses.
Complete data were collected from 683 participants (54.84% women; average age: 60.28 ± 17.02 years). Decreasing vision was associated with increasing costs (p < 0.001). Most costs were incurred by informal support from relatives, which was the most important resource for coping with everyday life for people with visual loss. Together with assistive/medical devices and loss of productivity due to disability, informal support accounted for 80% of total costs. Extrapolated to Germany, the annual costs of blindness and visual impairment from a societal perspective amounted to € 49.6 billion. Results of the sensitivity analyses and 95% confidence intervals showed a considerable degree of uncertainty.
Visual impairment and blindness may cause enormous overall costs from a societal point of view, as shown here for Germany. Our findings on the costs of blindness and visual impairment in Germany add in a number of different ways to the international evidence. In particular, results show that a large proportion of the costs are not obvious per se as it is caused by self-paid deductibles, productivity loss, early retirement and informal support/care by relatives. Further research should make special efforts to investigate these costs precisely as well as their influence factors.
视力障碍导致相当大且不断增加的经济负担，不仅影响视力受损者及其家庭，也影响社会。对于大多数国家来说，没有一个坚实的数据库可以从社会角度全面评估成本。本研究旨在填补这一空白。
调查盲或视力障碍者的资源利用情况，并评估德国盲和视力障碍的经济负担。
本研究采用患病成本法，从社会角度对盲和视力障碍者进行横断面研究。为此，通过国家自助组织（基于患病率的方法）招募盲人和视力障碍者，并通过各种调查模式（混合模式方法）对其使用的资源进行访谈。观察期为 6 个月回溯期。使用的资源采用标准化单位成本进行评估（宏观成本核算）。根据研究人群的计算结果，为 6 个月期间的每个人提供直接和间接成本。进一步将每个类别的成本推算到德国一般人群的 1 年。使用单变量确定性敏感性分析解决结果的不确定性。
共收集到 683 名参与者（54.84%为女性；平均年龄：60.28±17.02 岁）的完整数据。视力下降与成本增加相关（p<0.001）。最大的成本来自于亲属的非正规支持，这是非视力受损者日常生活应对中最重要的资源。与辅助/医疗设备和因残疾导致的生产力损失一起，非正规支持占总成本的 80%。从社会角度推算，德国盲和视力障碍的年度成本为 496 亿欧元。敏感性分析和 95%置信区间的结果显示存在相当大的不确定性。
从社会角度来看，视力障碍可能导致巨大的总体成本，德国的情况就是如此。本研究关于德国盲和视力障碍成本的发现以多种不同方式补充了国际证据。特别是，研究结果表明，很大一部分成本本身并不明显，因为这是由自费免赔额、生产力损失、提前退休和亲属的非正规支持/护理造成的。进一步的研究应该特别努力准确地调查这些成本及其影响因素。
