title: Association between visual acuity and medical and non-medical costs in patients with wet age-related macular degeneration in France, Germany and Italy.
abstract: BACKGROUND
  Exudative ('wet') age-related macular degeneration (ARMD) is the major cause of blindness in Western developed countries. Treatments aimed at preserving vision are already available and new compounds are under development. Micro-economics information will be pivotal to justifying forthcoming investment.
  
  
  OBJECTIVE
  This study sought to investigate the costs of exudative ARMD in patients who were actively treated at ophthalmology referral centres in three European countries: France, Germany and Italy.
  
  
  METHODS
  This cross-sectional observational study was conducted in France, Germany and Italy in 2004. The following data were collected: ARMD description, visual acuity (VA), and the medical and non-medical resources used for ARMD in the preceding year. The economic perspective was that of society. ANOVA for cost variables estimated the impact of ARMD per eye, adjusted for sex and age. Both hospital and ambulatory eye centres were included. Patients with exudative ARMD were stratified into four levels of severity using VA thresholds of 20/200 for the worst eye (WE) and 20/40 for the best eye (BE). The main outcome measure was medical and non-medical costs.
  
  
  RESULTS
  360 patients were included (females 60%; mean age 77 years; mean interval since diagnosis 2.3 years). The two groups with the greatest difference in severity of VA loss consisted of BE >or= 20/40, WE >or= 20/200 (27.2% of patients) and BE <20/40, WE <20/200 (25.5% of patients). Total cost was two-thirds medical and one-third non-medical. Total costs increased with ARMD severity and were 1.1-2 times greater for severe disease compared with less severe disease. Average medical costs (2004 values) in France were euro 3714, compared with euro 1810 in Germany and euro 2020 in Italy, and showed slight increases with ARMD severity. Non-medical costs were significantly higher for patients with severe disease and highest in Germany.
  
  
  CONCLUSIONS
  The impact of ARMD on costs was considerable and a positive correlation was found between total costs and ARMD severity. Differences among countries were partly explained by differences in customary care delivery.
authors.affiliation: University of Udine, Udine, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
authors.forename: Albert
authors.initials: A
authors.lastname: Augustin
authors.forename: José-Alain
authors.initials: JA
authors.lastname: Sahel
authors.forename: Hicham
authors.initials: H
authors.lastname: Benhaddi
authors.forename: Cristina
authors.initials: C
authors.lastname: Negrini
authors.forename: Klaus
authors.initials: K
authors.lastname: Hieke
authors.forename: Gilles H
authors.initials: GH
authors.lastname: Berdeaux
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003625:Data Collection; D005249:Fees and Charges; D005260:Female; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008268:Macular Degeneration / Q000191:economics* / Q000453:epidemiology; D008297:Male; D012720:Severity of Illness Index; D014792:Visual Acuity