Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland

Report from the launch of the Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland study, conducted by Deloitte and supported by Novartis.

Executive Summary

The National Vision Coalition, an alliance of ophthalmology healthcare professionals, those working in the sight loss community, and service users, held a special briefing on April 1, 2014 to launch the findings of the Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland report, and call for immediate implementation of a national vision strategy.

Currently, more than 220,000(1) people in Ireland are blind or vision impaired, and this figure is expected to grow substantially due to Ireland’s ageing population. A total 13,845 people in Ireland are now blind and this figure has increased by 7% since 2011, figures provided by the Coalition show(1).

According to the Coalition, the Government has just six years left to eliminate avoidable blindness, since it is committed to the World Health Organisation (WHO) objectives of Vision 2020.

The aim of the report, which is part of a pan-European study of 16 countries by Deloitte, was to analyse the impact and burden of blindness and the most prevalent eye diseases in Ireland, and to evaluate the cost-effectiveness of interventions to prevent eye disease and sight loss.

The report revealed that five people per week became blind in Ireland since 2010, despite 75-80% of blindness being preventable(1,2).

The report also found that 123 million workdays(3) are lost per year in Europe, while in Ireland 2.1 million healthy days are lost per annum(2) as a consequence of vision impairment and blindness. Blindness and vision impairment cost the Irish State €205 million in 2010, yet up to €76 million could potentially be saved if a series of cost-effective measures for the four main eye diseases in Ireland were implemented(2).

This potential saving is particularly relevant since the cost of blindness is expected to increase to €2.5 billion by 2020(1). These recommended interventions include screening for diabetic retinopathy, which allows for earlier access to treatment, if treatment is required; treatment with anti-VEGF for wet AMD; screening for cataracts; and access to surgery where needed.

Avril Daly, Chief Executive Officer of Fighting Blindness and joint Chairperson of the National Vision Coalition, opened the meeting and introduced the first speaker; Fine Gael Deputy Mary Mitchell O’Connor, who Ms Daly said had been very supportive of the activities of the Coalition.

Deputy Mitchell O’Connor said that every day we take simple things for granted, like seeing new daffodils, yet each week about five people go blind in Ireland.

She voiced her continuing support for the agenda of the Coalition and revealed that sight loss is a personal issue for her as her brother Anthony went blind around four years ago.

She noted the difficulties of people who are blind and vision impaired in securing employment, accessing services and public transport and negotiating traffic – straightforward tasks for sighted people.

“Blind people often tell me they feel invisible in society. I have been with Anthony my brother where questions about his health, his work, himself, have been addressed to me not to him, the patient. This makes my blood boil, but he just regards it as another challenge, another prejudice against people with disability,” she told the meeting.

She also stressed that it is even sadder that 75-80%(1,2) of blindness is preventable; citing the causes of diabetic retinopathy, wet AMD, cataracts, glaucoma. Deputy Mitchell O’Connor acknowledged that the rest of Europe faces similar issues, but added that with the population ageing, more people will be affected.

She said the new report not only looked at the human cost of blindness but also the serious economic impact of these diseases not being treated.

“If we introduce interventions such as screening for cataracts and diabetic retinopathy and other very early interventions we would ensure that for hundreds of people their sight is retained, and, according to this report, we would also be saving the State hundreds of millions of euro. This makes sense to me,” Deputy Mitchell O’Connor stated.

She then listed the objectives the Coalition believes should be in a national vision strategy:

(1) co-ordination and integration of services,

(2) a core focus of prevention and early intervention,

(3) knowledge and awareness among health professionals and the general public,

(4) research to promote healthy vision, eliminate avoidable sight loss and improve the quality of care, and

(5) inclusion- to ensure those affected are engaged in the design and delivery of support services.

“Blind people may be impaired but they are not invisible. I am personally committed to ensuring we put in place this national vision strategy to support those affected by sight loss. I am a member of the Oireachtas Health Committee and I will be bringing this report to their attention. I will also bring it to the Minister for Health Dr James Reilly,” Deputy Mitchell O’Connor told the meeting.

She said she was aware the Coalition had met with Minister Reilly in January, and that he broadly supports their idea of a national strategy, and added that the Coalition also presented its case “very well” to TDs and senators during its visit to the Dáil last July. She then confirmed that the details of a visit by the Coalition to the Oireachtas Health Committee would be finalised before the summer recess.

Finishing, Deputy Mitchell O’Connor thanked the Coalition for inviting her to help launch the report, and praised their important work.

Rationale for a National Vision Strategy

Avril Daly stressed the large numbers that are affected by vision loss in Ireland, currently around 220,000 with this number predicted to rise to 272,000 by 2020(1). Ms Daly also noted the Irish Government signed up in 2003 to the objectives of the WHO Vision 20-20 strategy to eliminate avoidable blindness by 75-80% by 2020(1,2).

“That is an ambitious target given where we are at in 2014 but there is a lot of important work underway currently in order to achieve that target,” Ms Daly stated, adding that a lot of the structures needed are already in place; it is more a matter of co-ordinating them.

Speaking about the rationale for a national vision strategy, she said current eye services are very fragmented and the strategy is therefore essential to adopt a more strategic approach to the design and development of vision health services in Ireland.

Ms Daly also welcomed the work underway in the HSE’s national clinical programme for eye care, and feels it will make a real impact on reducing avoidable sight loss. She then gave an update on the work of the Coalition, its reports to date, including its Strategic Framework for Vision Health, which proposes eight principles to guide the development of a future national vision strategy in Ireland, which was launched last year, and meetings with policymakers.

The financial cost of vision loss to the departments of health, social protection and finance was €205 million in 2010(4), but the implementation of a national vision strategy should save up to €76 million per year(2), she confirmed.

Finishing up, she stressed that up to 80 % of blindness(2), is preventable and that if people are diagnosed early enough their vision can be saved. “We don’t want any more people to go through the process of losing their sight where they don’t have to…. Even saving a little bit of vision makes a massive difference to people’s independence. There are five people going blind in this country every week and we feel that is unacceptable.”

Burden and Prevention: Implications for Ireland

Also speaking at the report launch, David Keegan, Consultant Ophthalmic Surgeon, Mater Misericordiae University Hospital, Dublin, and member of the Coalition, said that preventable blindness is a global issue, not just a third-world issue, and reiterated the Coalition’s commitment to tackling the issue in Ireland. He also echoed Ms Daly’s comments that many of structures are already in place in Ireland to tackle preventable blindness, but more help is needed from policymakers to co-ordinate a comprehensive and cohesive approach.

Mr Keegan said diabetic retinopathy is now no longer the leading cause of preventable blindness in the UK, ten years into their screening programme.

Giving specific examples of the burden of blindness/sight loss on healthcare services he revealed that people with vision loss are up to eight times more likely to fracture a hip, three times more likely to be depressed, and admission to nursing homes takes place up to three years earlier. Thus there is a significant financial benefit if sight loss can be avoided.

Continuing, Mr Keegan said the cost to the State increases significantly if a person progresses from being visually impaired (€1.7K per person per annum)(6) to being blind (€21K per person per annum)(4).

Looking at the Danish experience, he said the incidence of blindness due to AMD has now reduced by 50% through appropriate treatment, and outlines the savings that could be made in Ireland if such a targeted approach was taken.

Moving on, he confirmed that diabetes complications are the leading cause of blindness among the working age population in Ireland. It has been internationally recognised that screening and treatment of diabetic retinopathy is one of the most cost-effective interventions ever investigated, preventing 6% of potential blindness in the first year of treatment(7). Mr Keegan said the establishment of the Diabetic Retinopathy Screening Programme and the HSE’s National Programme for Eye Care has provided a real opportunity to achieve improved outcomes for people with sight loss in Ireland. There are approximately 145,000 diabetics on the programme register, and an estimated 4.5% (6,525) have sight-threatening retinopathy(6), Mr Keegan explained. About 2,900 will have the more severe form (PDR), half of whom could go blind if left untreated and these will need to be treated with laser, but 500 will require surgery (€2.5 million cost annually)(6). He also detailed the treatment estimates and costs for DME and other potential eye issues in these patients.

Mr Keegan also discussed the total cost of screening and treatment and sight loss costs under the Programme for six years (2013-2018). He said while it seems high at almost €100 million, it is only a net figure of just over €21 million if you consider the cost without screening or treatment and related vision loss costs(6). The programme will also prevent 235 cases of blindness, 696 cases of moderate vision impairment and 1,857 cases of mild vision impairment within that timespan(6).

Wrapping up his presentation, Mr Keegan outlined the eight key principles of the National Vision Strategy, concluding that the Coalition was happy to be accountable for the delivery of the Strategy.

“Everybody who sits on the Coalition; eye care is our job; not public speaking, not making policy, not pushing through Government. All we can do is make our case on the care centred approach that patients require but also the economic points; that’s the information that policymakers need. It has to pay for itself, it has to be cost effective so we’re asking you the policymakers in the room that you listen to this, and help us do our jobs to deliver that care. If you need accountability come back to us. If we are not delivering, ask us why and we will strive to do better and deliver on that.”

Call to Action

Des Kenny, Chief Executive Officer of the NCBI and joint Chairperson of the National Vision Coalition addressed the meeting. He thanked all the speakers for highlighting the humanity as well as the economic cost of sight loss, and spoke about the Coalition’s work on pushing for a national vision strategy, thanking Deputy Mitchell O’Connor and Senator Martin Conway for their support.

Mr Kenny acknowledged the challenges in achieving the Coalition’s aims, but again called for politicians to offer their support and ensure the strategy becomes a reality. “So when we meet this time next year we will be celebrating the existence of the national vision strategy and not just calling for it,” he concluded.

Ms Daly then thanked the meeting speakers, politicians and attendees for their support, and said she was heartened by the attendance of so many different stakeholders, which was what the Coalition was all about.

 

References:

1. Framework to Adopt a Strategic Approach for Vision Health in Ireland.  Accessed on 10 March 2014http://www.ncbi.ie/about-ncbi-ncbi-publications/framework-adopt-strategic-approach-vision-health-ireland-report-2012

2. The Economic Impact of Vision Impairment and Blindness in the Republic of Ireland. Accessed on 10 March 2014 https://www.ncbi.ie/about-ncbi/ncbi-publications/cost-of-sight-loss-report-2011

3. The Cost of Preventable Blindness Accessed on 10 March 2014 http://www.efabeu.org/media/1043/cob-infographic_pan-eu-results_14-october.pdf

4. The Economic Cost and Burden of Eye Diseases and Preventable Blindness in Ireland, Deloitte Access Economics, Deloitte Consulting, 2014.

5. Dr Omer Saka,Director, Deloitte Access Economics, Presentation ‘The burden of eye disease and preventable blindness’ 01 April 2014

6. Dr David Keegan, Retinal Specialist, Presentation ‘Burden & prevention – implications for Ireland’ 01 April 2014

7. Diabetic Retinopathy Screening Programme Accessed 09 April 2014http://www.diabetes.ie/wp-content/uploads/2011/06/Framework_for_a_Diabetic_Retinopathy_Screening_Programme_1.pdf.

8. Prof Ian Banks, Chair, European Forum Against Blindness (EFAB) Presentation ‘The European context’ 01 April 2014