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Economic burden of blindness and visual impairment in Germany from a societal perspective: a cost-of-illness study

  • Yuliya Chuvarayan
  • Robert P. Finger
  • Juliane Köberlein-NeuEmail author
Original Research

Abstract

Background

Visual impairment and blindness cause a considerable and increasing economic burden affecting not only persons with vision loss and their families, but also societies. For the majority of countries, there is no solid database that would allow a comprehensive assessment of costs from a societal perspective. The present study was conducted to fill this gap.

Objectives

To investigate resource utilization of blind or visually impaired people and to assess the economic burden of blindness and visual impairment in Germany.

Methods

This cross-sectional cost-of-illness study measures the economic burden of blindness and visual impairment bottom-up and from a societal perspective. Therefore, blind and visually impaired persons were recruited via national self-help organizations (prevalence-based approach) and interviewed regarding their utilized resources using various survey modes (mixed-mode approach). The observation period was 6 months retrospectively. Utilized resources were valued applying standardized unit costs (macro-costing). Calculations for the study population provided direct and indirect costs per person for a period of 6 months. Further cost per category was extrapolated to 1 year for the general population of Germany. Uncertainty of results was addressed applying univariate deterministic sensitivity analyses.

Results

Complete data were collected from 683 participants (54.84% women; average age: 60.28 ± 17.02 years). Decreasing vision was associated with increasing costs (p < 0.001). Most costs were incurred by informal support from relatives, which was the most important resource for coping with everyday life for people with visual loss. Together with assistive/medical devices and loss of productivity due to disability, informal support accounted for 80% of total costs. Extrapolated to Germany, the annual costs of blindness and visual impairment from a societal perspective amounted to € 49.6 billion. Results of the sensitivity analyses and 95% confidence intervals showed a considerable degree of uncertainty.

Conclusion

Visual impairment and blindness may cause enormous overall costs from a societal point of view, as shown here for Germany. Our findings on the costs of blindness and visual impairment in Germany add in a number of different ways to the international evidence. In particular, results show that a large proportion of the costs are not obvious per se as it is caused by self-paid deductibles, productivity loss, early retirement and informal support/care by relatives. Further research should make special efforts to investigate these costs precisely as well as their influence factors.

Keywords

Blindness Visual impairment Costs Cost of illness Societal perspective 

JEL Classification

I19 

Notes

Acknowledgements

The authors thank Fabian Steinbach for his help with the project coordination as well as for the organization of the survey and Verena Maschke for her support during the data entry. Special thanks are due to the DBSV, in particular Volker Lenk, Christiane Moeller and Andreas Bethke, for the enriching discussions and valuable comments in the context of the questionnaire tests as well as the critical revision of the manuscript. The authors also thank the Deutscher Verein der Blinden und Sehbehinderten in Studium und Beruf e.V. (DVBS) (the German association of blinds and visually impaired in studies and occupation registered association), the AMD-Netz NRW e.V. (Alltersabhaengige Makuladegeneration-Netz Nordrhein-Westfalen e.V.) (age-related macular degeneration net North Rhine-Westphalia registered association) and PRO RETINA Germany e.V., which made the dispatch of the study documents through their club magazine possible, the Berufsfoerderungswerk Düren gem. GmbH (engl.: vocational training center of the City Dueren) for their intensive evaluation of the online questionnaire and the SFZ Chemnitz for conducting the personal telephone interviews.

Funding

This work was supported by the Jackstaedt-Stiftung and Novartis Pharma GmbH (Grand numbers Date_09072014 and Date_26112014). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. No payment was received by any external funder or outside source for the writing of this manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

The study was approved by the responsible ethics committee of the University of Wuppertal prior to beginning of the study. All participants were informed about anonymity and voluntarily participation. Participants, who chose the paper–pencil or online version of our questionnaire, provided their implicit informed consent during the recruitment phase by agreeing to participate and by sending back the anonymous questionnaire. Respondents answering via personal telephone interview gave explicit informed consent during the recruitment phase by agreeing to participate and providing a telephone number for a re-call. The personally identifying information was not stored and participant responses were anonymized prior to analysis.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Center for Health Economics and Health Services Research, Schumpeter School of Business and EconomicsUniversity of WuppertalWuppertalGermany
  2. 2.Department of OphthalmologyUniversity of BonnBonnGermany

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