Humanistic and Economic Burden of Geographic Atrophy: A Systematic Literature Review

Abstract

Purpose

Geographic atrophy (GA), the advanced form of dry age-related macular degeneration, can result in irreversible blindness over time. We performed a systematic literature review to assess the humanistic and economic burden of GA.

Methods

Predefined search terms were used to identify studies in PubMed, Embase, and Cochrane Library; conference abstracts also were searched.

Results

Of 1111 unique studies identified, 25 studies on humanistic burden, 4 on economic burden, and 3 on both humanistic and economic burden of GA were included. Vision-related functioning and health-related quality of life (HRQOL) are poor in patients with GA. HRQOL is commonly measured using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25); patients with GA have significantly lower composite and subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision than individuals without GA. Driving is a particular concern, and inability to drive affects dependency. Vision-related quality of life (VRQOL) declines as GA progresses. While we identified only 7 reports describing the economic burden of GA, its direct costs may be substantial. In a US study, mean cost to the payer per patient with GA was $11,533 in the year after diagnosis. A multinational study estimated annualized total direct costs of €1772 per patient with GA, mainly driven by diagnostic tests and procedures (€1071). Patients with GA are at increased risk of falls and fractures, potentially increasing direct costs. Only one study evaluated indirect costs, estimating ~$24.4 billion in yearly lost wages among people with severe vision loss due to GA or drusen ≥125 μm.

Conclusion

GA represents a significant humanistic burden. Evidence on the economic impact of GA is limited; characterizing the economic burden of GA requires further research. Interventions that reduce GA-related disability may improve HRQOL and reduce indirect costs.

Keywords:

• dry age-related macular degeneration
• health-related quality of life
• vision-related quality of life
• costs

Abbreviations

AMD, age-related macular degeneration; AREDS, Age-Related Eye Disease Study; CES-D, Center for Epidemiological Studies Depression Scale; CI, confidence interval; CNV, choroidal neovascularization; FRI, Functional Reading Independence; GA, geographic atrophy; HRQOL, health-related quality of life; IQR, interquartile range; logMAR, logarithm of the minimum angle of resolution; nAMD, neovascular age-related macular degeneration; NEI VFQ-25, National Eye Institute Visual Function Questionnaire; SD, standard deviation; UK, United Kingdom; US, United States; VEGF, vascular endothelial growth factor; VF-14, Visual Function Index 14; VRQOL, vision-related quality of life.

Acknowledgments

Kate Lothman of RTI Health Solutions provided medical writing services during development of this manuscript. These services were funded by Apellis Pharmaceuticals. This study was conducted under a research contract between RTI Health Solutions and Apellis Pharmaceuticals and was funded by Apellis Pharmaceuticals.

Disclosure

SPS, WC, MI, and DLJ are employees of Apellis. AH, MB, and TT are employees of RTI Health Solutions. SW was an employee of RTI Health Solutions when this research was conducted. The author reports no other conflicts of interest in this work.