Economic impact of Keratoconus -a patient’s perspective

Abstract

Purpose : Unlike other common chronic ocular diseases, keratoconus (KC) primarily affects people in their teens and early adulthood extending through adulthood. There have been no studies evaluating the economic costs from a patient’s perspective. Hence, we conducted a cross-sectional study to evaluate the economic cost associated with KC and estimate the lifetime cost associated with the disease.

Methods : KC patients were recruited from public and private ophthalmology clinics in Melbourne, Australia. A keratoconus health expenditure questionnaire was designed to assess direct and indirect expenditures by these subjects. The participants completed this questionnaire, by referring to their bills or receipts, where possible. All analyses were performed using Stata 13.2.

Results : A total of 100 participants completed the questionnaire with a median age of 31 years [interquartile range (IQR) 23, 44] and 57% were males. The median and IQR for the total out of pocket cost of spectacles, contact lenses, contact lens solutions, eye drops and other equipment was AUD$ 1087.50 (650, 1885) per year; the cost of health visits to optometrists/ophthalmologists, hospital and other health services was AUD$ 378 (100, 1779); the cost of transportation to health visits was AUD$ 125 (45-300). The total cost related to direct and indirect care was AUD$ 3365 (2110, 8930).
The mean cost per KC subject per year was approximately AUD $4398 while the average household optician expenditure was $145 per annum (Australian households report 2008). This suggests they are paying 30-fold more than the general population.
By applying our cost data to the estimated keratoconus prevalence (1 in 2000) data for the Australian population, the total cost is approximately AUD$ 40.5 million per year in Australia.

Conclusions : Our results show that the costs associated with keratoconus diagnosis and management represent a significant cost to both patients and the health system. Most keratoconus patients are distinctly disadvantaged by current Australian government rebate and private health insurance policies and incur high out-of-pocket expenses involved with the treatment and management of the disease. With the increasing prevalence of keratoconus and the fact that we are seeing keratoconus affecting people at a much younger age in recent years, the study results highlight keratoconus as a public health concern.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.