title: The economic burden of visual impairment and blindness: a systematic review.
abstract: OBJECTIVE
  Visual impairment and blindness (VI&B) cause a considerable and increasing economic burden in all high-income countries due to population ageing. Thus, we conducted a review of the literature to better understand all relevant costs associated with VI&B and to develop a multiperspective overview.
  
  
  METHODS
  Systematic review: Two independent reviewers searched the relevant literature and assessed the studies for inclusion and exclusion criteria as well as quality.
  
  
  METHODS
  Interventional, non-interventional and cost of illness studies, conducted prior to May 2012, investigating direct and indirect costs as well as intangible effects related to visual impairment and blindness were included.
  
  
  METHODS
  We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement approach to identify the relevant studies. A meta-analysis was not performed due to the variability of the reported cost categories and varying definition of visual impairment.
  
  
  RESULTS
  A total of 22 studies were included. Hospitalisation and use of medical services around diagnosis and treatment at the onset of VI&B were the largest contributor to direct medical costs. The mean annual expenses per patient were found to be US$ purchasing power parities (PPP) 12 175-14 029 for moderate visual impairment, US$ PPP 13 154-16 321 for severe visual impairment and US$ PPP 14 882-24 180 for blindness, almost twofold the costs for non-blind patients. Informal care was the major contributor to other direct costs, with the time spent by caregivers increasing from 5.8 h/week (or US$ PPP 263) for persons with vision >20/32 up to 94.1 h/week (or US$ PPP 55 062) for persons with vision ≤20/250. VI&B caused considerable indirect costs due to productivity losses, premature mortality and dead-weight losses.
  
  
  CONCLUSIONS
  VI&B cause a considerable economic burden for affected persons, their caregivers and society at large, which increases with the degree of visual impairment. This review provides insight into the distribution of costs and the economic impact of VI&B.
authors.affiliation: Department of Health Economics und Health Care Management, University of Wuppertal, Wuppertal, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Köberlein
authors.forename: Karolina
authors.initials: K
authors.lastname: Beifus
authors.forename: Corinna
authors.initials: C
authors.lastname: Schaffert
authors.forename: Robert P
authors.initials: RP
authors.lastname: Finger
keywords: Blindness; Cost of Illness; Health Economics; Visual Impairment