Economic Resources Utilized in a Cohort of Patients with Age–Related Macular Degeneration

Abstract

Abstract: : Purpose: To determine the economic resources utilized in a cohort of patients with age–related macular degeneration. Methods: We conducted an IRB–approved, resource utilization study to determine the economic resources used by a cohort of AMD patients over a historical 12–month period. The study was performed from the societal perspective. We evaluated costs through two primary techniques; the administration of an interviewer–administered questionnaire, and through review of participants' clinic charts. From these two data sources, we evaluated both direct medical costs and direct non–medical costs (such as home support and assessment and low vision rehabilitation including CCTV magnifiers). Indirect costs incurred by family members related to medical visits and supportive care were evaluated, but productivity was not due to the low employment rate in this demographic. Statistical analyses included determining the mean and variance about the main cost drivers. In addition, we performed a series of multivariate models to evaluate if visual dysfunction and other clinical variables were associated with economic resources utilized. Results: The 41 subjects included in this analysis had a mean age of 79.6 years (SD 6.1); 64 % were females. Seventy–four percent of the sample had wet AMD, and 38.4% of the sample had bilateral wet disease. Many subjects had a relatively new–onset of their disease; the sample's median duration of disease was 16.9 months. The mean logMAR visual acuity of the sample was 0.51 in the better seeing–eye (20/65) and 1.17 in the worse–seeing eye (20/300). The mean annual cost per patient in this sample was $3944.62 (CND). Direct medical costs were the main cost driver, accounting for 91% ($3605) of total costs. Multivariate linear regression using stepwise variable selection demonstrated that both duration (p = 0.02) and visual acuity in the better–seeing eye (p = 0.05) were significantly associated with increasing consumption of direct non–medical resources. Conclusions: Direct medical resource utilization is the predominant cost driver in those with relatively new–onset AMD. Direct non–medical costs increase in importance as patient visual acuity deteriorates, especially in the better–seeing eye.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • age–related macular degeneration • quality of life