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Purola PKM, Taipale J, Väätäinen S, Harju M, Koskinen SVP, Uusitalo HMT. Price tag of glaucoma care is minor compared with the total direct and indirect costs of glaucoma: Results from nationwide survey and register data. PLoS One 2023; 18:e0295523. [PMID: 38117760 PMCID: PMC10732367 DOI: 10.1371/journal.pone.0295523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/21/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The estimations of the economic burden of glaucoma have focused on comparing different treatment modalities; hence, the total direct and indirect costs of glaucoma at population level are not well known. OBJECTIVE To estimate the direct and indirect costs of glaucoma and its treatment in Finland. METHODS Economic and glaucoma data were collected from the cross-sectional nationwide Health 2000 health examination survey linked to multiple national registers, which allowed a 13-year follow-up between 1999-2011 among survey participants. Direct costs covered eye- and non-eye-related hospitalizations and outpatient visits, outpatient health care services, and travel costs among participants aged 30 years or older, adjusted for age and sex. Indirect costs covered premature retirement and productivity losses among participants aged 30-64 years. Glaucoma patients (n = 192) were compared with non-glaucomatous population (n = 6,952). RESULTS The annual additional total direct costs were EUR 2,660/glaucoma patient, EUR 1,769/glaucoma patient with medication, and EUR 3,979/operated glaucoma patient compared with persons without glaucoma. The respective additional total indirect costs were EUR 4,288, EUR 3,246, and EUR 12,902 per year. In total, the additional annual direct and indirect expenditures associated with glaucoma in Finland were EUR 202 million (0.86% of total expenditures of health care) and EUR 71 million (0.03% of the Finnish gross domestic product) arising mainly from non-eye-related hospitalizations and productivity losses, respectively. CONCLUSION Glaucoma is associated with an increased health care consumption mainly due to non-eye-related health care, which can be explained by the vision loss as well as increased number of co-morbidities among glaucoma patients. Therefore, glaucoma constitutes a major economic burden for the health care system and society, highlighting the importance of early glaucoma interventions. The difference in direct and indirect costs between glaucoma treatment groups is explained by the uneven distribution of co-morbidities.
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Affiliation(s)
- Petri K. M. Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Joonas Taipale
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Mika Harju
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo V. P. Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu M. T. Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tays Eye Center, Tampere University Hospital, Tampere, Finland
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Purola PKM, Ojamo MUI, Gissler M, Uusitalo HMT. Changes in Visual Impairment due to Diabetic Retinopathy During 1980-2019 Based on Nationwide Register Data. Diabetes Care 2022; 45:2020-2027. [PMID: 35838317 PMCID: PMC9472510 DOI: 10.2337/dc21-2369] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate changes in the incidence, prevalence, severity, and onset age of visual impairment (VI) due to diabetic retinopathy (DR) and compare these trends in the screening and treatment of diabetes during 40 years based on Finnish national register data. RESEARCH DESIGN AND METHODS We included people with VI with nonproliferative DR (NPDR; n = 2,490, 73% women) or proliferative DR (PDR; n = 2,026, 53% women) as the main diagnosis for VI during 1980-2019 in the Finnish Register of Visual Impairment. The number of patients with treated diabetes during 1986-2019 was obtained from the Social Insurance Institution of Finland registers based on reimbursed medication data. RESULTS The annual incidence of reported VI due to DR has decreased since it peaked in the 1990s: regarding NPDR, it decreased from 102.3 to 5.5 per 100,000 patients with treated diabetes between the 1990s and 2010s; regarding PDR, the respective change was from 39.9 to 7.4. The incidence of patients with diabetes treated for DR increased during this period. Annual prevalence of reported VI and differences between sexes steadily decreased in the 2000s and 2010s. The severity of reported VI has decreased, and the age at the onset of reported VI increased during the 40 years. CONCLUSIONS Prevalence and incidence of VI due to DR have dramatically decreased and shifted to older age during the 40 years despite the increasing prevalence of diabetes. These positive trends highlight the successful development and effectiveness of screening and therapies for diabetes and DR.
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Affiliation(s)
- Petri K M Purola
- SILK, Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Matti U I Ojamo
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland.,Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Hannu M T Uusitalo
- SILK, Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland.,Tays Eye Centre, Tampere University Hospital, Tampere, Finland
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Purola PKM, Nättinen JE, Ojamo MUI, Rissanen HA, Gissler M, Koskinen SVP, Uusitalo HMT. Prevalence and 11-Year Incidence of Cataract and Cataract Surgery and the Effects of Socio-Demographic and Lifestyle Factors. Clin Ophthalmol 2022; 16:1183-1195. [PMID: 35480623 PMCID: PMC9035455 DOI: 10.2147/opth.s355191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the impact of cataract in ageing population by evaluating the prevalence, incidence, and background factors of cataract and cataract surgery. Patients and Methods Two health examination surveys representing Finnish population in 2000 and 2011 included 7380 and 5930 participants aged 30 years or older with cataract status known. An 11-year follow-up included 4840 persons who participated in both the surveys. The data include information on physician-made diagnoses, socio-demographic factors, and lifestyle factors based on self-reported assessment. Cataract diagnoses and surgeries recorded in the Finnish Care Register for Health Care were linked to the survey data. Cataract patients were compared to those without cataract using logistic regression. Differences in cataract surgery age were evaluated using linear regression. Univariable and multivariable models were included. Results During 2000–2011, the prevalence of cataract increased from 8.8% to 13.6% and cataract surgery from 5.7% to 8.9% in a representative sample of the Finnish adult population. Cataract and cataract surgery were associated with age, smoking, and high alcohol consumption. Cataract was also associated with female gender and low income in 2000, but this association declined during the 11 years. Smoking and high alcohol consumption were associated with younger surgery age. Conclusion The prevalence of cataract and cataract surgery is increasing with the ageing of the population. The increase in cataract surgery is likely also reflecting the improvements in eye care. The possibility to equally use health-care services throughout a country can reduce the impact of socio-demographic status. Healthy lifestyle delays the development of cataract, whereas smoking and high alcohol consumption are associated with earlier cataract development. Therefore, the availability of cataract services and promotion of healthy lifestyle will be the key to prevent the detrimental effects of cataract on patients and the society in countries where the population is rapidly ageing.
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Affiliation(s)
- Petri K M Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Correspondence: Petri KM Purola, Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Tel/Fax +358 400 695309, Email
| | - Janika E Nättinen
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti U I Ojamo
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
| | - Harri A Rissanen
- Information Services Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden
- Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden
| | - Seppo V P Koskinen
- Information Services Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hannu M T Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Helsinki, Finland
- Tays Eye Center, Tampere University Hospital, Tampere, Finland
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Purola PKM, Nättinen JE, Ojamo MUI, Koskinen SVP, Rissanen HA, Sainio PRJ, Uusitalo HMT. Prevalence and 11-year incidence of common eye diseases and their relation to health-related quality of life, mental health, and visual impairment. Qual Life Res 2021; 30:2311-2327. [PMID: 33755897 PMCID: PMC8298234 DOI: 10.1007/s11136-021-02817-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2021] [Indexed: 01/10/2023]
Abstract
Purpose To study the prevalence and incidence of the most common eye diseases and their relation to health-related quality of life (HRQoL), depression, psychological distress, and visual impairment in the aging population of Finland. Methods Our study was based on two nationwide health surveys conducted in 2000 and 2011. Eye disease status data were obtained from 7379 and 5710 individuals aged 30 + years, of whom 4620 partook in both time points. Both surveys included identical indicators of HRQoL (EuroQol-5 Dimension [EQ-5D], 15D), depression (Beck Depression Inventory [BDI]), psychological distress (General Health Questionnaire-12 [GHQ-12]), visual acuity, and self-reported eye diseases. We assessed the impact of known eye diseases on these factors, adjusted for age, gender, and co-morbidities. Results Prevalence of self-reported eye diseases was 3.1/2.7% for glaucoma, 8.1/11.4% for cataract, and 3.4/3.8% for retinal degeneration in 2000 and 2011, and the average incidence between 2000 and 2011 was 22, 109, and 35 /year/10,000 individuals, respectively. These eye diseases were associated with a significant decrease in EQ-5D and 15D index scores in both time points. BDI and GHQ-12 scores were also worsened, with some variation between different eye diseases. Impaired vision was, however, the strongest determinant of declined HRQoL. During the 11-year follow-up the effect of eye diseases on HRQoL and mental health diminished. Conclusion Declined HRQoL associated with eye diseases is more related to impaired vision than the awareness of the disease itself, and this declining effect diminished during the follow-up. Therefore, information directed to the public on the risks and prevention of blindness can and should be strengthened to prevent the deleterious effects of visual impairment. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02817-1.
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Affiliation(s)
- Petri K M Purola
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Arvo building, 33014, Tampere, Finland. .,Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Marjaniementie 74, 00930, Helsinki, Finland.
| | - Janika E Nättinen
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Arvo building, 33014, Tampere, Finland
| | - Matti U I Ojamo
- Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Marjaniementie 74, 00930, Helsinki, Finland.,Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
| | - Seppo V P Koskinen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
| | - Harri A Rissanen
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
| | - Päivi R J Sainio
- Finnish Institute for Health and Welfare, Mannerheimintie 166, 00270, Helsinki, Finland
| | - Hannu M T Uusitalo
- Department of Ophthalmology, Faculty of Medicine and Health Technology, Tampere University, Arvo building, 33014, Tampere, Finland.,Finnish Register of Visual Impairment, Finnish Federation of the Visually Impaired, Marjaniementie 74, 00930, Helsinki, Finland.,Tays Eye Center, Tampere University Hospital, Biokatu 14, 33520, Tampere, Finland
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