Eye-related medicare costs for patients with age-related macular degeneration from 1995 to 1999

Objective: Age-related macular degeneration (AMD) is the leading cause of blindness and severe visual impairment among the elderly in the United States. This study aims to assess eye-related Medicare costs from 1995 to 1999 in patients with both nonneovascular and neovascular AMD as compared with controls, and to delineate whether variations exist across demographic and clinical subgroups in eye-related Medicare costs over 5 years. Design: Retrospective, observational, population-based analysis. Participants: Five percent random sample of Medicare beneficiaries. Methods: Data were obtained from the 5% random sample of Medicare beneficiaries with diagnoses of nonneovascular and neovascular AMD. A control group was selected based on diagnoses of blepharitis, chronic conjunctivitis, or blepharoconjuctivitis and no diagnosis of AMD. Eye-related claims were totaled and compared for each group over the 5-year study period. Demographic and clinical factors potentially influencing eye-related costs were also examined. Main Outcome Measures: Eye-related Medicare costs during the 5-year study period. Results: Median eye-related Medicare costs were estimated at $1607 for neovascular AMD patients, $832 for nonneovascular AMD patients, and $658 for controls. Cost differences across groups were significant based on univariate and multivariate analyses (P<0.001). In linear regression analysis, males and blacks had significantly lower eye-related Medicare costs than females and whites, respectively (P<0.001). Conclusions: Age-related macular degeneration represented a significant economic burden to the U.S. health care system for a single ophthalmic disease entity based on Medicare reimbursed eye-related costs before the availability of photodynamic therapy and anti-vascular endothelial growth factor therapy. Given that direct eye-related costs associated with the treatment of neovascular AMD are estimated at $569 million annually before the availability of therapy for subfoveal lesions, effective therapeutic measures may be associated with substantial cost offsets. Ophthalmology 2008;115:18-25 (c) 2008 by the American Academy of Ophthalmology.