FISCAL IMPACT OF NEOVASCULAR AGE-RELATED MACULAR DEGENERATION IN THE UNITED STATES A GOVERNMENT EXPENDITURE PERSPECTIVE
Author(s)
Foteini Tsotra, Jr., MSc1, Lulu Lee, PhD2, Karla Hernandez-Villafuerte, PhD3, Joelle A. Hallak, MS, PhD4, nikil patel, PharmD5, Platon Peristeris, PhD6, Omar Jouini, MSc7, Eric Hillson, PhD5, Malina Müller, BA, MA, PhD3, Joice T. Huang, PharmD2.
1Laboratory of Health Economics & Management, University of Piraeus, Athens, Greece, Athens, Greece, 2AbbVie, Irvine, CA, USA, 3WifOR Institute, Darmstadt, Germany, 4Associate Director, RWE, HEOR, AbbVie, Chicago, IL, USA, 5AbbVie, Chicago, IL, USA, 6WifOR Institute, Athens, Greece, 7WifOR GmbH, Darmstadt, Germany.
1Laboratory of Health Economics & Management, University of Piraeus, Athens, Greece, Athens, Greece, 2AbbVie, Irvine, CA, USA, 3WifOR Institute, Darmstadt, Germany, 4Associate Director, RWE, HEOR, AbbVie, Chicago, IL, USA, 5AbbVie, Chicago, IL, USA, 6WifOR Institute, Athens, Greece, 7WifOR GmbH, Darmstadt, Germany.
OBJECTIVES: Neovascular age related macular degeneration (nAMD) is an increasing burden on the U.S. healthcare system, extending beyond clinical management to substantial public spending on healthcare, long term care, and caregiver support. This study quantifies the government perspective of nAMD in the U.S., focusing on estimating the public expenditures related to healthcare resource utilization (HCRU) and long term care needs.
METHODS: A patient level microsimulation fiscal impact model quantified the public expenditures associated with nAMD over a lifetime. HCRU Costs included ophthalmologist visits, imaging, and antiVEGF injection administration, reflecting a public payer perspective. Depression, anxiety and fracture related costs were also included, to account for nAMD related comorbidities on public spending. Home health care and skilled nursing facility (SNF) services were incorporated using Medicare data. Long term services and supports were modelled using Medicaid-financed services, including home and community based services (HCBS) and institutional care. Informal caregiving support was captured via the National Family Caregiver Support Program (NFCSP). Utilization was adjusted using published odds ratios for visual impairment severity. Microsimulation results were extrapolated to an incident population of 222,133 patients annually to estimate total national expenditure.
RESULTS: The total public expenditure burden of nAMD over the lifetime was estimated at US$381.4 billion across the modelled patient population, driven by healthcare costs and LTSS. Direct healthcare costs accounted for US$292.6 billion (Medicare US$290.3 billion; Medicaid US$2.3 billion), while Medicaid LTSS represented US$54.8 billion. Out of these, HCBS and SNF incurred US$39.0 and US$15.8 billion, respectively. Medicare home health and SNF were estimated at US$16.0 and US$18.0 billion, respectively. Expenditures related to informal caregiver support (NFCSP) amounted to US$0.05 billion.
CONCLUSIONS: nAMD represents a substantial burden on public expenditures in the U.S., driven largely by long term care needs and ongoing disease management, highlighting the need for more durable and effective therapies to reduce healthcare costs.
METHODS: A patient level microsimulation fiscal impact model quantified the public expenditures associated with nAMD over a lifetime. HCRU Costs included ophthalmologist visits, imaging, and antiVEGF injection administration, reflecting a public payer perspective. Depression, anxiety and fracture related costs were also included, to account for nAMD related comorbidities on public spending. Home health care and skilled nursing facility (SNF) services were incorporated using Medicare data. Long term services and supports were modelled using Medicaid-financed services, including home and community based services (HCBS) and institutional care. Informal caregiving support was captured via the National Family Caregiver Support Program (NFCSP). Utilization was adjusted using published odds ratios for visual impairment severity. Microsimulation results were extrapolated to an incident population of 222,133 patients annually to estimate total national expenditure.
RESULTS: The total public expenditure burden of nAMD over the lifetime was estimated at US$381.4 billion across the modelled patient population, driven by healthcare costs and LTSS. Direct healthcare costs accounted for US$292.6 billion (Medicare US$290.3 billion; Medicaid US$2.3 billion), while Medicaid LTSS represented US$54.8 billion. Out of these, HCBS and SNF incurred US$39.0 and US$15.8 billion, respectively. Medicare home health and SNF were estimated at US$16.0 and US$18.0 billion, respectively. Expenditures related to informal caregiver support (NFCSP) amounted to US$0.05 billion.
CONCLUSIONS: nAMD represents a substantial burden on public expenditures in the U.S., driven largely by long term care needs and ongoing disease management, highlighting the need for more durable and effective therapies to reduce healthcare costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE580
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Methodological & Statistical Research
Topic Subcategory
Novel & Social Elements of Value, Work & Home Productivity - Indirect Costs
Disease
Sensory System Disorders (Ear, Eye, Dental, Skin)