title: Direct costs of blindness experienced by patients enrolled in managed care.
abstract: OBJECTIVE
  To evaluate total and condition-related charges incurred by blind patients in a managed care population in the United States and compare total charges with those of a matched nonblind cohort.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Patients with blindness (N = 10 796) and a 1:1 matched cohort of nonblind patients were selected from a managed care claims database. All study subjects were required to be > or =18 years old at diagnosis (blind patients) or enrollment (nonblind patients) and to have had > or =1 years of continuous follow-up.
  
  
  METHODS
  Total and pharmacy-related direct medical charges in the first year of follow-up were calculated for both blind and nonblind cohorts. Among blind patients, condition-related charges, charge per treated person, and charge breakdown by age group were calculated. For patients with follow-up extending past 1 year, total charges (both cohorts) and condition-related charges (blind cohort only) were assessed and annualized. Mean and median charges were assessed for blind and nonblind patients within each stratum of matched covariates; a multivariate linear regression assessed the statistical significance of the difference in charges between the 2 cohorts.
  
  
  METHODS
  Total health care charges in the first year of follow-up and condition-related health care charges in the first year of follow-up for blind patients.
  
  
  RESULTS
  For the blind population (mean age, 52 years [standard deviation (SD), 17.5]), the total mean and median health care charges per person in the first year were $20,677 (SD, $48,835) and $6854, respectively. Total mean and median health care charges per nonblind patient in the first year were $13,321 (SD, $40,059) and $3778, respectively. Condition-related charges among blind patients were substantially lower than total charges, with mean and median charges per person of $4565 (SD, $17,472) and $371, respectively. After adjusting for covariates, blind patients had significantly higher total health care charges in the first year of follow-up than nonblind patients (P<0.0001). Costs of the blind did not differ substantially from costs of the normally sighted in subsequent years of follow-up.
  
  
  CONCLUSIONS
  This study demonstrates the substantial direct cost burden of blindness during the first year of follow-up in a managed care population.
authors.affiliation: Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: John G
authors.initials: JG
authors.lastname: Walt
authors.forename: Tina H
authors.initials: TH
authors.lastname: Chiang
authors.forename: John J
authors.initials: JJ
authors.lastname: Doyle
authors.forename: Lee S
authors.initials: LS
authors.lastname: Stern
authors.forename: Laura M
authors.initials: LM
authors.lastname: Katz
authors.forename: Margarita
authors.initials: M
authors.lastname: Dolgitser
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Hendlish
mesh_terms: D000368:Aged; D001766:Blindness / Q000191:economics*; D017281:Cost of Illness; D016208:Databases, Factual; D004180:Direct Service Costs; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D019987:Persons with Visual Disabilities