The Backgrounder: Burden of Illness of Neovascular Age-related Macular Degeneration - an International Evaluation

Burden of Illness Study

The Burden of Illness Study was conducted in Canada and Europe (France, Germany, Spain and UK). It is a comparative study looking at the human burden of people suffering from wet age-related macular degeneration (AMD).

The study examines the difference between patients with the disease and a control group of patients of a similar age in general medical care. Details of the study are outlined below.

Study participants were all 50 years of age or older

Patients had wet AMD in both eyes


Control group patients had at best corrected visual acuity of 20/40 or better:

  • These patients were free from any ocular pathology that may impair visual acuity, including diagnosed diabetic retinopathy, glaucoma, or cataract surgery within six months prior to assessment for the study

Both economic and humanistic outcomes were measured:

  • Economic outcomes included: low-vision services and equipment, assisted living services and social welfare benefits
  • Humanistic outcomes included visual functioning, quality-of-life, mental health and economic outcomes, including AMD diagnosis and treatment; vision-related falls and injuries and treatment of psychiatric illness

The study sponsored by Pfizer Ophthalmics, is a multinational, cross-sectional, comparative, observational study on the effects wet AMD. It examined subject self-reported functional health, well-being and disease burden among elderly subjects with and without subfoveal exudative AMD, also known as wet AMD.

Burden of Illness Study Key Results

IMPACT OF WET AMD ON EVERYDAY LIVES Wet AMD has a major impact on the daily lives of those who have the disease, though this is largely underestimated by both the public and clinicians.

Wet AMD patients have approximately a third of the ability of people with normal visual function to perform everyday 'nearby' activities such as:

  • Reading a newspaper
  • Cooking
  • Reading street signs
  • Walking down steps and curbs in low light

They have under a half of the ability of people with normal visual function to perform everyday 'distance' activities such as:

  • Recognising faces
  • Watching television
  • Taking part in outdoor activities

DEPENDENCE ON OTHERS

Wet AMD can be debilitating and patients need significantly more practical support and assistance in performing daily activities than those with normal vision.

The burden of care falls heavily on family members who often become the primary caregivers

People with wet AMD find their independence is often dramatically diminished, preventing them from performing tasks previously taken for granted:

  • Almost a third (29%) of wet AMD patients require help with normal everyday activities, which is over four times as many as people with normal sight (7%)
  • Patients with wet AMD are more likely to be injured in everyday life than those with normal vision. They are twice more likely to fall than patients with normal vision, increasing risk of fracture and need for medical assistance

EMOTIONAL REPERCUSSIONS

Dependence on others and an increased difficulty performing everyday tasks can lead to anxiety and depression. A wet AMD patient feels unable to function in society as they could in the past, leading to serious emotional problems.

  • On average, patients with wet AMD are almost twice as depressed as people with normal vision
  • As the severity of AMD increases, equally the patient's feelings of depression rise
  • In the 12 months preceding the study, patients with wet AMD received more treatment for anxiety and depression than people with normal vision, placing additional financial strain on limited healthcare resources

THE IMPORTANCE OF EARLY DETECTION/EARLY TREATMENT

There is considerable risk of irreversible vision loss if wet AMD is not detected and treated early.

  • It takes just over a year (14-15 months average) for those with untreated wet AMD to progress to legal blindness or worsened vision
  • Early detection through regular periodic eye exams is vital, as a patient with wet AMD can begin to lose vision in as little as three months after detection
  • The earlier treatment begins, the more vision will be preserved. Just a small window of opportunity is available to alter the course of the disease, which is why early intervention is crucial

THE ECONOMIC BURDEN

AMD has significant direct and indirect costs to society.

  • Direct costs include inpatient and outpatient expenses, home health visits, nursing care, and social services. Indirect costs include work absence and lost productivity
  • On average, the annual cost exceeds €1.5 billion per country, not including additional home costs
  • AMD poses significant financial burden to society with the annual average cost per patient across Europe costing significantly more than for control patients in general medical care.

Recently presented at ARVO - Cruess et al. Humanistic Burden and Health Resource Utilization Among Neovascular Age-Related Macular Degeneration (AMD) Patients: Results from a Multi-Country Cross-Sectional Study. Presented at ARVO 2006 April 30 - May 4, 2006, Fort Lauderdale, Florida. This research was supported by Pfizer Ophthalmics.