Original article
LXIII Edward Jackson Memorial Lecture: Eye Care: Dollars and Sense

https://doi.org/10.1016/j.ajo.2006.10.003Get rights and content

Purpose

The development of health economic data for vision loss and eye disease is described.

Design

Data from population-based epidemiologic studies of eye disease, studies of the impact of vision loss on daily living, Australian national health-care costs, census, and demographic projections were combined to develop a model of the economic impact of vision loss in Australia.

Methods

Data were considered to assess the current magnitude and costs of vision loss and to make projections as to future costs. Further analysis investigated the costs and economic benefits of various interventions to address avoidable vision loss.

Results

The amount of vision loss increases three-fold and the number with vision loss will double in 20 years. Vision loss cost Australia a total of AU $9.85 billion in 2004. Vision loss ranks seventh in causes of loss of well-being. An intervention package to address avoidable vision loss would cost AU $190 million or AU $5,591/Quality Adjusted Life Year (QALY) and give lifetime savings of AU $911 million.

Conclusions

Although specific for Australia, these data can help guide health care policy debate and the priority given to eye care in other developed economies. For each dollar spent on the prevention of vision loss and eye care, there is a 5 dollar return to the community.

Section snippets

The priority given to vision loss

Like all ophthalmologists, Jackson instinctively knew the importance of good vision and eye health. The treatment of eye disease and the prevention of blindness is our highest priority; it is our calling. As ophthalmologists, we all accept the importance of good vision without question.

In 1980, the World Health Organization (WHO) asked me to review eye services in Pakistan at the request of the Pakistani government. When I presented my report to the Pakistani Minister of Health, he received the

Population-based evidence

Epidemiologic field studies can provide a wide range of information. In ophthalmology, they have given us great information about the prevalence and incidence of eye diseases and disease risk factors. In 1991, there were no coherent data on the magnitude or causes of vision loss in Australia. At best, only fragmented reports were available. To address this gap, the “Melbourne Visual Impairment Project” (VIP) was started. It was a large, population-based survey to determine the prevalence and

The prevalence and causes of vision loss

These various epidemiologic surveys carried out in different countries show a remarkably consistent picture. Even though there may be large differences in ethnic minorities, economic status, and health care delivery in these different developed economies, the age-specific rates and causes of vision loss are remarkably consistent. These studies demonstrated that the amount of vision loss and eye disease increases dramatically with increasing age. For each decade over the age of 40, the amount of

The impact of vision loss

Over the last few years, studies in Australia and in the US have shown that even relatively small degrees of visual impairment can have a major impact on the quality and length of life. The critical level of vision is that level usually required for an unrestricted driving license. People with less than 20/40 vision have a significantly increased risk of falls,28, 29 hip fractures,30, 31 and depression.32, 33 They have a substantial loss of social independence,34, 35 and they are likely to be

The costs of vision loss

More recently, we have analyzed the economic impact and cost of vision loss in Australian communities.37, 38 We found that vision loss and its costs had been totally overlooked.

Throughout the following analyses I have used Australian dollars. The exchange rate is usually AU $1.00 to between US $0.70 to US $0.75. International dollars have been introduced to give a comparison of the relative Purchasing Power Parity of a currency in its own country, sometimes called the “Big Mac Index”.39 In

The costs of eye care

Most blindness and vision loss now can be prevented or treated, usually by highly cost-effective measures. You will remember that WHO considers an intervention to be cost-effective if it costs less than three times GDP per capita to avert one lost Quality Adjusted Life Year or QALY (an economic measure of a year of good health).45 In Australia, this threshold is set at less than $112,000 per QALY . However, if an intervention costs less than one GDP per capita, $37,000 per QALY, then is very

Dollars and sense

At long last, armed with this information, we now are able to discuss priorities with health bureaucrats and policy makers, and Ministers of Health, in a way we could not do in the past. We now have the information that is required to place the needs for eye care in perspective and to compare it with other health priorities. We can quantify and rank the impact of vision loss and of even more importance, the cost of not addressing it.

In November 2005, the Australian governments released a

Hugh R. Taylor, AC, MD, Since 1990 he has been a Professor and Head of Ophthalmology at the University of Melbourne, Australia, and Managing Director of the Centre for Eye Research Australia. Trained at Melbourne, he was at Johns Hopkins for 13 years. Dr Taylor has written extensively on epidemiologic and public health aspects of eye disease and is a leader in Vision 2020 and the International Council of Ophthalmology. Dr Taylor was made a Companion in the Order of Australia in 2001.

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    Hugh R. Taylor, AC, MD, Since 1990 he has been a Professor and Head of Ophthalmology at the University of Melbourne, Australia, and Managing Director of the Centre for Eye Research Australia. Trained at Melbourne, he was at Johns Hopkins for 13 years. Dr Taylor has written extensively on epidemiologic and public health aspects of eye disease and is a leader in Vision 2020 and the International Council of Ophthalmology. Dr Taylor was made a Companion in the Order of Australia in 2001.

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