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Economic Studies

The multiple eye disease simulation model (MEDS)

Vision loss and blindness impose a great social and economic burden on individuals and society. The total annual economic impact of vision problems in the United States reaches approximately $51.4 billion. Good vision is important for good quality of life, and loss of vision leads to disability, morbidity, and loss of productivity. CDC and Research Triangle Institute (RTI) Multiple Eye Disease Simulation (CR-MEDS) model is a natural history model of age-related macular degeneration (AMD), glaucoma, cataracts, and diabetic retinopathy. This discrete simulation model was built using AnyLogic, a simulation tool from XJ Technologies. Parameters to govern patient disease progression and vision loss, service utilization, and costs were drawn from published studies, national survey data, and primary data analyses. Quality adjusted life year (QALY) values were assigned to each health state from no impairment to severe blindness to track the impact of vision loss and blindness on cumulative morbidity during the life of an age cohort. During development, the model’s structure and inputs were reviewed by an expert panel of leading research ophthalmologists and ophthalmologic epidemiologists.

Economic burden of eye diseases and visual impairment in adult Americans

This study estimated the combined economic impact of AMD, cataracts, diabetic retinopathy, glaucoma, and refractive error among Americans aged 40 years and older. The study estimated a total financial burden of major visual disorders of $35.4 billion comprised of $16.2 billion in direct medical costs, $11.1 billion in other direct costs, and $8 billion in productivity losses, in 2004. Annually, the federal government and state Medicaid agencies pay at least $13.7 billion of these costs.


Rein DB, Zhang P, Wirth KE, et al. The economic burden of major adult visual disorders in the United States. Arch Ophthalmol 2006;124(12):1754–1760.

Cost-effectiveness model for Diabetic Retinopathy

Diabetic retinopathy is a major cause of blindness in the United States, causing 12,000–24,000 new cases each year. However, only about half of persons with type 2 diabetes on average received an annual eye examination. A number of factors suggest that emerging telemedicine screening with appropriate referral may be a highly cost-effective and potentially cost-saving alternative. The purpose of this study is to update estimates of the cost-effectiveness of routine screening of diabetics for diabetic retinopathy and also include the new technology of telemedicine in the evaluation.

Cost-effectiveness model for Amblyopia

In the United States, amblyopia remains one of the leading causes of monocular blindness and is considered to be an important pubic health problem. The treatment of amblyopia is usually effective and permanent for the remaining life of the child. The purpose of this project is to investigate the cost-effectiveness of amblyopia screening among pre-school children that will delay or prevent vision loss, and identify the optimal screening strategy for children in the United States.

Cost-effectiveness model for comprehensive eye examination

As the U.S. population ages and changes demographically, the impact of vision loss and visual disability will grow substantially in the future. Approximately 3.3 million American adults aged 40 years and older were visually impaired, and more than 11 million Americans aged 12 years and older needed refractive correction. The purpose of this project is to investigate the cost-effectiveness of comprehensive eye examination screening that will delay or prevent vision loss and blindness caused by major eye diseases, and identify the optimal screening strategy for the U.S. population.

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Cost-effectiveness Model for Age-Related Macular Degeneration

This study simulated the incidence and natural history of age-related macular degeneration (AMD) with and without the use of prophylactic antioxidant vitamin plus zinc supplements to prevent advanced vision threatening disease. The study found that the universal use of vitamin therapy would reduce the percentage of patients with early AMD who ever developed visual impairment in the better-seeing eye to 5.6% compared to 7.0% without such therapy. Compared to no therapy, vitamin therapy cost approximately $21,000 per Quality adjusted life (QALY) gained, in 2003 dollars, a cost that was favorable compared to other ocular health interventions.


Rein DB, Saaddine JB, Wittenborn JS, et al. Cost-effectiveness of vitamin therapy for age-related macular degeneration. Ophthalmology 2007;114(7):1319–1326.
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The Economic Impact of Vision Problems Report

This report combined the work of two teams of prominent health economists. David B. Rein, PhD, of RTI International led one team, and Kevin D. Frick, PhD, of Johns Hopkins Bloomberg School of Public Health, led the other team. Rein’s research was funded by the Vision Health Initiative of the Centers for Disease Control and Prevention (CDC); Frick’s research was funded by Prevent Blindness America. They delved into public sources of data, teasing out the impact of vision problems on federal and state budgets, personal expenditures and health-related quality of life. Impact of Vision Problems [PDF–197 KB]

Cost-effectiveness Model for Glaucoma

Using a computer model, this study simulated glaucoma incidence, natural progression, diagnosis, and treatment. The study evaluates whether routine assessment and treatment of glaucoma enhances quality of life at a reasonable cost.


Rein DB, Wittenborn JS, Lee PP, Wirth KE, Sorensen SW, Hoerger TJ, Saaddine JB. The cost-effectiveness of routine office-based identification and subsequent medical treatment of primary open-angle glaucoma in the United States. Ophthalmology 2009;116(5):823–832.
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Rein DB, Wirth KE, Johnson CA, Lee PP. Estimating quality-adjusted life year losses associated with visual field deficits using methodological approaches. Ophthalmic Epidemiol 2007;14(4):258–264.
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