• John S Wittenborn, Xinzhi Zhang, Charles W Feagan, Wesley L Crouse, Sundar Shrestha, Alex R Kemper, Thomas J Hoerger, Jinan B Saaddine, and Vision Cost-Effectiveness Study Group.
• Department of Public Health Research, NORC at the University of Chicago, Morrisville, North Carolina 27560, USA. wittenborn-john@norc.org
• Ophthalmology. 2013 Sep 1;120(9):1728-35.

ObjectiveTo estimate the economic burden of vision loss and eye disorders in the United States population younger than 40 years in 2012.DesignEconometric and statistical analysis of survey, commercial claims, and census data.ParticipantsThe United States population younger than 40 years in 2012.MethodsWe categorized costs based on consensus guidelines. We estimated medical costs attributable to diagnosed eye-related disorders, undiagnosed vision loss, and medical vision aids using Medical Expenditure Panel Survey and MarketScan data. The prevalence of vision impairment and blindness were estimated using National Health and Nutrition Examination Survey data. We estimated costs from lost productivity using Survey of Income and Program Participation. We estimated costs of informal care, low vision aids, special education, school screening, government spending, and transfer payments based on published estimates and federal budgets. We estimated quality-adjusted life years (QALYs) lost based on published utility values.Main Outcome MeasuresCosts and QALYs lost in 2012.ResultsThe economic burden of vision loss and eye disorders among the United States population younger than 40 years was $27.5 billion in 2012 (95% confidence interval, $21.5-$37.2 billion), including $5.9 billion for children and $21.6 billion for adults 18 to 39 years of age. Direct costs were $14.5 billion, including $7.3 billion in medical costs for diagnosed disorders, $4.9 billion in refraction correction, $0.5 billion in medical costs for undiagnosed vision loss, and $1.8 billion in other direct costs. Indirect costs were $13 billion, primarily because of $12.2 billion in productivity losses. In addition, vision loss cost society 215 000 QALYs.ConclusionsWe found a substantial burden resulting from vision loss and eye disorders in the United States population younger than 40 years, a population excluded from previous studies. Monetizing quality-of-life losses at $50 000 per QALY would add $10.8 billion in additional costs, indicating a total economic burden of $38.2 billion. Relative to previously reported estimates for the population 40 years of age and older, more than one third of the total cost of vision loss and eye disorders may be incurred by persons younger than 40 years.Financial Disclosure(S)The author(s) have no proprietary or commercial interest in any materials discussed in this article.Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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