Future Sight Loss UK 1 - Full Report

The economic impact of partial sight and blindness in the UK adult population

Contents

Executive summary

1. Background

1.1 Definitions of partial sight and blindness

1.2 Conditions leading to partial sight and blindness

2. Prevalence of partial sight and blindness

2.1 Population data

2.2 Prevalence rates by age, gender, ethnicity, severity and major region

2.3 Prevalence of partial sight and blindness in the UK

2.4 Projections of prevalence to 2050

3. Health care system expenditure

3.1 Hospital recurrent expenditure

3.2 Non-admitted expenditure

3.3 Prescribing expenditure in primary care

3.4 General ophthalmic services

3.5 Expenditure associated with injurious falls

3.6 Research and development

3.7 Residential care and community care sectors

3.8 Capital and Administration

3.9 Summary of health care system expenditure

4. Indirect costs

4.1 Productivity losses

4.2 Informal care costs

4.3 Devices and modifications

4.4 Deadweight loss

4.5 Summary of indirect costs

5. Burden of disease

5.1 Methods used for measuring and valuing the burden of disease

5.2 Burden of disease from partial sight and blindness

6. Projection of health care system costs and indirect costs

7. International comparisons

8. Case studies

8.1 Promote the prevention of eye injuries

8.2 Improved access to integrated low vision and rehabilitation services

8.3 Regular eye tests for the older population

8.4 Improved access to eye care services for minority ethnic groups

9. Conclusions

10. Appendix A

11. References

Figures

Figure 21: Age distribution of projected minority ethnic population in the UK, 2008

Figure 31: Proportion of recurrent hospital expenditure in England, by condition2008

Figure 32: Breakdown of non-commercial UK health research funding, 2003-04

Figure 51: Share of the burden of disease across conditions2008

Figure 52: Burden of disease across conditions, by severity of sight loss, 2008

Figure 61: Projected total costs due to partial sight and blindness in the UK

Figure 81: Proportion of eye injury presented to A&E, by activity

Figure 82: Distribution of benefit/cost ratio from campaign to reduce eye injuries

Figure 83: Proportion of low vision appointments offered by provider type

Tables

Table 11: Summary of costs associated with partial sight and blindness in UK adults2008

Table 21: Projected regional population by ethnicity, 2008

Table 22: Projected UK country population by ethnicity, 2008

Table 23: Projected UK country population by ethnicity, 2010-2050

Table 24: Prevalence of partial sight and blindness for the UK population 75 years and older (binocular visual acuity <6/18)

Table 25: Causes of Partial sight and blindness (binocular visual acuity <6/18)

Table 26: Causes of partial sight and blindness by age and sex (binocular visual acuity <6/18)

Table 27: Causes of partial sight and blindness (binocular visual acuity <6/18)

Table 28: Partial sight and blindness prevalence ( per cent) by age, gender, cause & severity (75+)

Table 29: Partial sight and blindness prevalence ( per cent) by age, gender, cause & severity (55-74)

Table 210: Partial sight and blindness prevalence ( per cent) by age, gender, cause & severity (<55)

Table 211: Relative risk of selected eye diseases due to ethnicity

Table 212: Summary of prevalence sources

Table 213: Partial sight and blindness (<6/12) by age, gender & disease type, UK(people)2008

Table 214: Blindness (<6/60) by age, gender & disease type, UK(people)2008

Table 215: Partial sight and blindness by age, gender & severity, UK(people)2008

Table 216: Partial sight and blindness (<6/12) by age, gender & ethnicity, UK(people)2008

Table 217: Projection of partial sight and blindness (<6/12) by gender & ethnicityUK(people)

Table 218: Projection of partial sight and blindness (<6/12) by disease type, UK(people), 2010 to 2050

Table 31: Hospital recurrent expenditure associated with partial sight and blindness in England2008

Table 32: Hospital recurrent expenditure in devolved countries2008

Table 33: Hospital recurrent expenditure in the UK2008

Table 34: Private hospital expenditure in the UK related to partial sight and blindness2008

Table 35: Outpatient costs for England2008

Table 36: Other outpatient services costs for England, by service type2008

Table 37: Other outpatient services costs for England, by condition2008

Table 38: Outpatient and other community services NHS expenditure for the UK2008

Table 39: Outpatient and other community services private expenditure for the UK2008

Table 310: Community eye prescription expenditure for England2008

Table 311: Community eye prescription expenditure for England, by condition2008

Table 312: Public expenditure for prescribing within primary care2008

Table 313: Public GOS Expenditure on persons ≥18 years of age2008

Table 314: Number of eye tests in Scotland, by condition, 2007-08

Table 315: Public GOS expenditure on people ≥18 years of age, by condition2008

Table 316: Private GOS Expenditure by persons ≥18 years of age2008

Table 317: Odds ratio of falls and hip fractures due to sight loss

Table 318: Prevalence of depression in those with sight loss

Table 319: Number of-episodes related to falls for total UK population, 2006-07

Table 320: Estimated episodes related to falls due to partial sight and blindness in the UK2008

Table 321: Public cost of episodes related to falls due to partial sight and blindness in the UK2008

Table 322: BBSRC R&D expenditure2008

Table 323: DALYs for sense organ diseases, by cause and gender, 2001

Table 324: Breakdown of non-commercial UK health research funding2008

Table 325: Expenditure on social services for adults with physical disability and older people in England, 2006-07

Table 326: Estimated expenditure on community services for those with sight loss in England2008

Table 327: Estimated expenditure on community services for those with sight loss, Devolved Nations2008

Table 328: Summary of health care system expenditure, by country2008

Table 329: Summary of health care system expenditure, by condition2008

Table 41: Employment rates, by level of seeing difficulty2007

Table 42: Employment gap and median gross income for those with sight loss2008

Table 43: Productivity loss due to partial sight and blindness2008

Table 44: Productivity loss due to absent days resulting from partial sight and blindness2008

Table 45: Cost of premature mortality from partial sight and blindness2008

Table 46: Number of informal carers in the UK by age, sex and hours spent providing care, 2006-07

Table 47: Number of informal carers in the UK providing care to those with partial sight and blindness, 2008

Table 48: Total direct payments to people with sight loss and informal carers, by direct payment type2008

Table 49: Summary of indirect costs2008

Table 51: DALYs associated with disability from partial sight and blindness in the UK2008

Table 52: Estimated number of deaths due to sight loss2008

Table 61: Projected health care system costs due to partial sight and blindness in the UK

Table 62: Projected indirect costs due to partial sight and blindness in the UK

Table 71: International comparison of the economic cost of partial sight and blindness

Table 81: Estimated Number of eye injuries in the UK workplace

Table 82: Estimated A&E visits, hospitalisations, and severity of eye injury, 2007-08

Table 83: Estimated NHS costs due to eye injury2008

Table 84: Estimated benefits from an educational program to avoid eye injury

Table 85: Inputs varied in the Monte Carlo simulation

Table 86: Types of services received

Table 87: Professionals consulted in the year after registration

Table 88: Cost of additional Low Vision Services2008

Table 89: Reduction in DALYs per year due to the campaign2008

Table 810: Inputs varied in the Monte Carlo simulation

Table 811: People with partial sight and blindness not in touch with eye care services2008

Table 812: Prevalence of undetected mild sight loss (<6/12 to 6/18) in the UK2008

Table 813: Frequency of eye tests, by age

Table 814: Number of sight tests for the older population in the UK, 2008

Table 815: Sight test fee in England, Wales and Northern Ireland

Table 816: Sight test fees in Scotland

Table 817: Estimated cost of additional treatment2008

Table 818: Estimated total cost of a campaign to increase sight tests2008

Table 819: Inputs varied in the Monte Carlo simulation

Table 820: Estimated prevalence of undetected partial sight in MEGs in the UK2008

Table 821: DALYs avoided through corrected vision as a result of the campaign

Table 822: Estimated reduction in DALYs from avoiding further reduction in partial sight in MEGs

Table 823: Estimated cost of additional treatment to MEGs

Table 824: Total cost of a campaign to increase MEG eye care access

Table 825: Inputs varied in the Monte Carlo simulation

Glossary of Acronyms

AMD: age-related macular degeneration
CPI: consumer price index (a measure of inflation)
DALY: disability adjusted life year
DoH: Department of Health
DR: diabetic retinopathy
FY: financial year
GDP: gross domestic product
HSE: Health and Safety Executive
MEGs: minority ethnic groups
MVIP: Melbourne Visual Impairment Project
QALY: quality adjusted life year
RE: refractive error
RNIB: Royal National Institute of Blind people
VSL(Y): value of a statistical life (year)
WHO: World Health Organization
WTP: willingness to pay
YLD: years of healthy life lost due to disability
YLL: years of life lost due to premature mortality

Acknowledgements

Access Economics would like to acknowledge with appreciation the insightful comments received on previous drafts of this report from the Expert Advisory Group and EpiVision, including Jennifer Beecham, Parul Desai, Alistair Fielder, Anita Lightstone, David Lye, Barbara McLaughlan, Pritti Mehta, Darwin Minassian (EpiVision), John Ravenscroft, Angela Reidy (EpiVision) and Steve Winyard.

Executive Summary

Access Economics (Australia) was commissioned by the Royal National Institute of Blind People (RNIB) to estimate the economic impact of partial sight and blindness in the UK adult population, including the direct and indirect costs of partial sight and blindness, and the burden of partial sight and blindness on health. In addition, Access Economics was asked to undertake an international comparison (Australia, US, Japan, and Canada) and several cost effectiveness analyses on strategic interventions that are expected to prevent and ameliorate the impact of sight loss in the UK adult population.

The economic costs presented in this report relate to the adult UK population (18 years of age or over). Although prevalence of partial sight and blindness has been estimated and reported for those aged 0 to 39, these data must be used with caution. Data on the prevalence of childhood partial sight and blindness in the UK is limited and variable. More research needs to be undertaken into measuring childhood partial sight and blindness and the associated economic costs within the UK.

This report comprises the following estimates:

·  prevalence of partial sight and blindness in the UK by age, gender, ethnicity, severity, major region and major cause in 2008, and future projections by decade to the year 2050;

·  the direct health system costs of partial sight and blindness in the UK adult population, disaggregated by cost components (hospital, non-admitted, prescribing in primary care, ophthalmic services, research and development, residential care and community care, capital and administration) for the year 2008;

·  the indirect costs of partial sight and blindness in the UK adult population, disaggregated by cost components (including productivity losses, informal care costs, devices and modifications, and the tax inefficiencies associated with transfer payments and public funding of health care) for the year 2008;

·  the burden of disease, measured in terms of disability adjusted life years (DALYs), of partial sight and blindness in the UK adult population, disaggregated by years of life lost due to premature death (YLL) and healthy years of life lost due to disability (YLD), and converted into a reasonable monetary equivalent;

·  projection of health care system costs and indirect costs for 2009 to 2013;

·  a comparison with other countries – Australia, US, Canada and Japan; and

·  economic evaluation of four hypothetical eye care programs to inform recommendations for rational, cost-effective service delivery, development and improvement in policy and practice.

The results of the study indicate that partial sight and blindness in the adult population places a large economic cost on the UK, totalling £22.0 billion in 2008. Direct health care system costs amount to £2.14 billion and indirect costs amount to £4.34 billion. In addition, the loss of healthy life and the loss of life due to premature death associated with partial sight and blindness also impose a cost on society through a reduction in the stock of health capital. This reduction was estimated at £15.51 billion in 2008. A detailed breakdown of direct and indirect costs, and the reduction in the stock of health capital associated with the burden of disease is shown in Table 11.

Table 11: Summary of costs associated with partial sight and blindness in UK adults2008

Direct costs / £ million
Hospital recurrent expenditure / 592.74
Non-admitted expenditure / 507.99
Prescribing expenditure / 158.12
General ophthalmic services (GOS) / 484.04
Expenditure associated with injurious falls / 25.10
Research and development / 13.99
Residential care and community care services / 304.69
Capital and administration / 58.22
Total – Direct costs / 2,144.89
Indirect costs
Lower employment / 1626.70
Absenteeism / 79.85
Premature mortality / 2.38
Informal care costs / 2,029.70
Devices and modifications / 336.50
Deadweight loss / 268.59
Total – Indirect costs / 4,343.72
Burden of disease costs
Years of life lost due to morbidity / 14,530.67
Years of life lost due to premature death / 978.43
Total – Burden of disease costs / 15,509.10
Total –Costs / 21,997.71

Source: Access Economics calculations

In addition to estimating the economic cost of partial sight and blindness in the UK adult population, four hypothetical eye care interventions were evaluated to estimate their potential cost effectiveness. These focused on four areas that have been identified as most relevant for current policy, and include:

·  promote the prevention of eye injuries;

·  improve access to integrated low vision and rehabilitation services;

·  increase regular eye tests for the older population (≥ 60 years); and

·  increase access to eye care services for minority ethnic groups (MEGs).

The results show that the most effective campaign is expected to be one that focuses on MEGs. This is because their access to eye care services is lower than the average population and their undetected eye conditions are more likely to be severe. It was estimated that an educational campaign using media and an educational road show to ten locations heavily populated with MEGs throughout the UK could result in a cost effectiveness ratio of £1,230 per DALY avoided (90 per cent confidence interval of £1,032 per DALY avoided to £1,559 per DALY avoided).