ImportanceAge-related macular degeneration (AMD) is a highly prevalent and debilitating retinal condition that affects more than 200 million people globally, with the severe late-stage forms—neovascular AMD (nAMD) and geographic atrophy (GA)—affecting more than 11 million people globally. However, much is unknown about the economic burden of the disease.ObjectiveTo estimate the economic burden associated with late-stage AMD in Bulgaria, Germany, and the US at the societal level.Design, Setting, and ParticipantsThis study used the prevalence approach cost-of-illness economic modeling to estimate costs attributable to late-stage AMD. Data on health care resource utilization, well-being, and productivity were obtained via primary data collection. Additional data required for the model were sourced from available published literature. Data were collected from January 2021 to March 2022, and analyzed from April to July 2022. Participants older than 50 years residing in Bulgaria, Germany, and the US who were diagnosed with late-stage AMD (nAMD or any form of GA) in 1 or both eyes and caregivers who care for people diagnosed with late-stage AMD were recruited through ophthalmological clinics in Bulgaria and Germany and via online newsletters and social media in the US.Main Outcomes and MeasuresThe main outcomes were direct medical costs (disease-related health care expenditures), indirect medical costs (care support and assistive technology), well-being cost (loss of well-being), and productivity cost (loss in productivity due to the diseases for both patient and caregivers).ResultsOf the 128 individuals with late-stage AMD in this study, 80 (62%) were female, and 120 (94%) were aged 60 years or older. Of the 61 caregivers, 43 (70%) were female and 55 (91%) were aged 45 years or older. Estimated per-annum total costs attributable to late-stage AMD were €449.5 million ($512.5 million) in Bulgaria, €7.6 billion ($8.6 billion) in Germany, and €43.2 billion ($49.4 billion) in the US. Across all countries, 10% to 13% of the total cost incurred was attributed to direct medical costs. In Germany and Bulgaria, the biggest contributor to the total economic burden was reduced well-being (67% and 76%, respectively), whereas in the US, loss of productivity (42%) was the biggest contributor.Conclusions and RelevanceThe findings of this study indicate a substantial burden of late-stage AMD on patients and caregivers in the US, Germany, and Bulgaria. Across the 3 countries, reduced well-being and loss of productivity were relatively large contributors to the total economic burden. Implementing measures to reduce AMD incidence, delay disease progression, and alleviate humanistic burden may help reduce the economic burden of late-stage AMD.

中文翻译：

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保加利亚、德国和美国晚期年龄相关性黄斑变性的经济负担


重要性年龄相关性黄斑变性 （AMD） 是一种非常普遍且使人衰弱的视网膜疾病，影响全球超过 2 亿人，其中严重的晚期形式——新生血管性 AMD （nAMD） 和地理萎缩 （GA）——影响了全球超过 1100 万人。然而，关于这种疾病的经济负担，还有很多未知数。目的估计保加利亚、德国和美国在社会层面与晚期 AMD 相关的经济负担。设计、环境和参与者本研究使用患病率方法疾病成本经济模型来估计归因于晚期 AMD 的成本。通过原始数据收集获得有关医疗保健资源利用率、福祉和生产力的数据。该模型所需的其他数据来自可用的已发表文献。数据收集时间为 2021 年 1 月至 2022 年 3 月，并于 2022 年 4 月至 7 月进行分析。居住在保加利亚、德国和美国的 50 岁以上被诊断患有 1 眼或双眼晚期 AMD（nAMD 或任何形式的 GA）的参与者以及照顾被诊断患有晚期 AMD 患者的护理人员是通过保加利亚和德国的眼科诊所以及美国的在线通讯和社交媒体招募的。主要结局和措施主要结局是直接医疗成本（与疾病相关的医疗保健支出）、间接医疗成本（护理支持和辅助技术）、福利成本（福祉的损失）和生产力成本（患者和护理人员因疾病造成的生产力损失）。结果在本研究的 128 名晚期 AMD 患者中，80 名 （62%） 为女性，120 名 （94%） 年龄在 60 岁或以上。 在 61 名护理人员中，43 名 （70%） 是女性，55 名 （91%） 年龄在 45 岁或以上。据估计，保加利亚的晚期 AMD 每年总成本为 4.495 亿欧元（5.125 亿美元），德国为 76 亿欧元（86 亿美元），美国为 432 亿欧元（494 亿美元）。在所有国家/地区，所发生总费用的 10% 至 13% 归因于直接医疗费用。在德国和保加利亚，造成总经济负担的最大因素是福利感下降（分别为 67% 和 76%），而在美国，生产力损失 （42%） 是最大的贡献者。结论和相关性本研究的结果表明，晚期 AMD 对美国、德国和保加利亚的患者和护理人员造成了沉重的负担。在这 3 个国家中，福祉下降和生产力损失是造成总经济负担的相对较大的因素。采取措施降低 AMD 发病率、延缓疾病进展和减轻人文负担可能有助于减轻晚期 AMD 的经济负担。