The burden of age-related macular degeneration: a value-based medicine analysis.
OBJECTIVE
To assess the quality-of-life loss and the macroeconomic financial consequences associated with age-related macular degeneration (ARMD).


METHODS
Time tradeoff utility analysis was performed to assess the quality-of-life diminution caused by ARMD (both dry and neovascular) in cohorts consisting of (1) patients with ARMD, (2) ophthalmologists asked to assume they had various degrees of severity of ARMD, (3) healthcare providers asked to assume they had various degrees of severity of ARMD, and (4) participants from the general community asked to assume they had various degrees of severity of ARMD. ARMD was classified according to vision in the better-seeing eye as (1) mild: 20/20 to 20/40, (2) moderate: 20/50 to 20/100, (3) severe: < or = 20/200, or (4) very severe: < or = 20/800.


RESULTS
Mild ARMD caused a 17% decrement in the quality of life of the average patient, similar to that encountered with moderate cardiac angina or symptomatic human immunodeficiency virus syndrome. Moderate ARMD caused a 32% decrease in the average patient's quality of life, similar to that associated with severe cardiac angina or a fractured hip. Severe ARMD caused a 53% decrease in quality, more than that of dialysis, and very severe ARMD caused a 60% decrease in the average ARMD patient's quality of life, similar to that encountered with end-stage prostate cancer or a catastrophic stroke that leaves a person bedridden, incontinent, and requiring constant nursing care. Patients with varying degrees of severity of ARMD were found to have quality-of-life impairment ranging from 96% to 750% greater than that estimated by treating ophthalmologists for the same condition. An economic analysis based upon losses to the gross domestic product suggests that ARMD has approximately a $30 billion annual negative impact. The return on investment is therefore potentially high for both treatment with current ARMD therapies and the research costs invested in the development of new ARMD treatment modalities.


CONCLUSIONS
ARMD is a major public health problem that has a devastating effect upon patients and marked adverse financial consequences for the economy.
Brown
Gary C
GC
Center for Value-Based Medicine, Flourtown, Pennsylvania, USA.
Brown
Melissa M
MM
Sharma
Sanjay
S
Stein
Joshua D
JD
Roth
Zachary
Z
Campanella
Joseph
J
Beauchamp
George R
GR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D017281:Cost of Illness; D004470:Economics, Medical; D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D008136:Longevity; D008268:Macular Degeneration / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D008875:Middle Aged; D009885:Ophthalmology; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology