Paying the Price

The cost of vision loss

C

anadian eye care is facing a “perfect storm” caused by the combination of an aging population and the fact that the major eye diseases causing vision loss are all age-related. (see figure 1)

Figure 1: Projected cases of vision loss in Canada 2007 - 2032

The extent of this crisis – the financial cost and its personal and social impact – has never been accurately measured. For this reason, in 2008, CNIB collaborated with the Canadian Ophthalmological Society to commission Access Economics Pty Limited, an independent economic consulting firm, to carry out a comprehensive study of the cost of vision loss in Canada and its impact on governments, employers, and all Canadians. Specialists in model-based health forecasting, Access Economics is the foremost organization worldwide doing this kind of study (to date they have done similar work in Australia, the United States, the United Kingdom and Japan).

Using conservative methodology, the Cost of Vision Loss in Canada study built on existing, authoritative sources of Canadian data and research, taking into account Canada’s multicultural society and projected demographics. It used known costs, accurately reflecting real expenditures and federal and provincial government policies. The study estimated the cost of vision loss in Canada using a prevalence-based approach. The cost estimates included direct health system expenditures on eye conditions that cause vision loss, as well as other indirect financial costs such as productivity losses. Estimates were also made of the value of the loss of healthy life, measured in Disability Adjusted Life Years (DALY).

The total financial cost

This study found the annual price tag associated with blindness and partial sight in Canada is exceptionally large – much higher than previous estimates. At $15.8 billion (in 2007 dollars)¹ (see figure 2), the cost amounts to 1.19 per cent of Canada’s GDP. ² In spite of this extraordinary sum there are still more than 800,000 Canadians living with blindness and partial sight, far too many of whom live in social isolation, experience poverty, and face unemployment and discrimination.

Figure 2: Total financial costs of vision loss, 2007

The largest financial cost was associated with direct expenditures in our health system, at $8.6 billion annually.¹ When placed alongside all other categories in the Public Health Agency of Canada’s Economic Burden of Illness in Canada (EBIC) study ³, which used similar methodology to that used by Access Economics, vision loss had the highest direct health care costs of any disease, costing Canadians much more than diabetes, cancer, cardiovascular disease, mental disorders, respiratory diseases (pneumonia, influenza, COPD, and asthma), arthritis or osteoporosis (see figures 3 and 4).

Figure 3: Direct costs of vision loss compared to other disease categories

Figure 4: Total financial costs of vision loss compared to other disease categories

Indirect costs such as lost productivity, administration, and care and rehabilitation also play a large role, amounting to $7.2 billion annually.¹ After health care costs, the second-highest financial cost from vision loss results from lost productivity – what people with blindness or partial sight would earn if they were able to fully participate in the workforce – which amounts to $4.4 billion a year.¹ The employment rate of people who are blind or partially sighted is an abysmal 35 per cent.⁴ When compared with other EBIC disease categories, vision loss ranked fourth in overall financial costs (direct and indirect) compared to other diseases.³ (Figure 4)

The human cost

The burden of disease (also known as the cost of suffering) was estimated at $11.7 billion per year1 using DALY’s (disability adjusted life years), which takes into account the disability and premature death associated with any disease. Although the $11.7 billion figure is not a true financial cost, it is an important measure of the human toll that must be accounted for along with the significant financial costs associated with eye disease and injury. It also provides a useful benchmark for policymakers. At CNIB, we focus on ability and strength when it comes to blindness and partial sight, not disability and suffering. However, the study acknowledged a different reality. The fact is that while blindness and partial sight are not fatal, their impact on quality of life can be severe, even in a developed country such as Canada. These results were a reminder of the magnitude of vision loss and the difficulties that must be overcome, particularly when someone first loses their sight.

Vision loss has wide-ranging implications. It affects work, income, self-esteem, dignity, family relationships, the ability to drive, leisure activities, community involvement and the activities of daily living. People who lose their sight may not enjoy the same rights and benefits that other Canadians enjoy, and they may experience social isolation and stigma. And while vision loss itself may not be fatal, it can precipitate other serious health impacts, such as clinical depression, and for seniors, falls and early admission to nursing homes. Most elderly people with vision loss also experience a wide range of co-morbidities.

The need for a vision health plan

Canadians will never be able to reduce the overwhelming human and financial cost of vision loss without an overall strategy to get us there. In response to the study, CNIB came up with 23 recommendations ² directed to different stakeholder groups to address the vision health crisis. The overarching recommendation is as follows:

“In 2003, Canada made a commitment to the World Health Organization (WHO) to develop and implement a national vision plan by 2005 and begin implementing the plan by 2007. To date, no such plan exists for Canada. Canada’s governments and vision health stakeholders need to work with absolute urgency to create and implement this plan. Further delay would be morally unconscionable and financially irresponsible.”

Many other nations made the same commitment to the WHO in 2003 under Vision 2020, The Global Initiative for the Elimination of Avoidable Blindness, and are well on their way with implementing their plans. To date there is no plan for Canada.

Yet since 2003, more than 262,000 Canadians have developed blindness or partial sight (see figure 5). Every year we wait, it costs us $15.8 billion. Every additional year, another 43,800 Canadians lose their vision.⁴

Figure 5: Canadians who have developed vision loss since 2003

references:

1. Access Economics Pty Ltd. The Cost of Vision Loss in Canada. Toronto: CNIB; 2008, iv. Available at: www.cnib.ca/covl. Accessed January 2010.
2. CNIB. Paying the Price: What Vision Loss Costs Canadians and What We Should Do About It. Toronto: CNIB; 2009, 5. Available at: www.cnib.ca/covl Accessed January 2010.
3. CNIB and Canadian Ophthalmological Society. The Cost of Vision Loss in Canada: Summary Report. Toronto: CNIB; 2009. Available www.cnib.ca/covl. Accessed January 2010
4. Social and Aboriginal Statistics Division, Statistics Canada. Participation and Activity Limitation Survey 2006.

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