<p>Burden of Illness in Geographic Atrophy: A Study of Vision-Related Quality of Life and Health Care Resource Use</p>

Abstract

Purpose: To gain comprehensive information on the burden of illness due to geographic atrophy (GA). Methods: This cross-sectional study with a retrospective chart review involved patients aged ≥70 years with physician-confirmed bilateral symptomatic GA due to age-related macular degeneration (GA group), as well as patients of similar age with no ophthalmic condition that in the opinion of the investigator affected visual function (non-GA group). Data relating to patients' current disease status and sociodemographics were self-reported on patient questionnaires at study entry and extracted from patient charts. Historical data on health care resource utilization (HCRU) were also collected via patient questionnaires and retrospective chart review (GA group only). Overall vision-related functioning and quality of life (QoL) were compared between the GA and non-GA groups using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) composite and subscales, and change in vision over the past year was assessed using the Global Rating of Change Scale. Results: Vision-related functioning and QoL were poorer in patients with vs without GA (n=137 vs 52), as demonstrated by significantly lower NEI-VFQ-25 composite score (mean, 53.1 vs 84.5 points, respectively; P<0.001), as well as lower subscale scores for near activities, distance activities, dependency, driving, social functioning, mental health, role difficulties, color vision, and peripheral vision. Substantially more patients with GA than without GA reported worsening in vision over the past year (82% vs 25%, respectively; odds ratio, 13.55; P<0.001). In the GA group, associated mean annual costs for direct ophthalmological resource use per patient amounted to €1772 (mostly for tests/procedures), and for indirect ophthalmological resource use, €410 (mostly for general practitioner visits). Conclusion: Patients with GA experience a poorer level of vision-related function and QoL than their peers, especially in relation to driving. GA is also associated with notable HCRU/ associated costs, mostly direct costs attributed to diagnostic tests/procedures.

Seeing Beyond Anatomy: Quality of Life with Geographic Atrophy

“…GA has a substantial effect on an individual’s mobility and independence [ 35 , 49 ]. One of the main reasons for reduced independence for people with GA is its effect on the ability to drive; over half of all people with GA who have a valid driving licence do not feel confident driving during the day and the majority would not drive at night [ 35 ]. In one study, 66.7% of people diagnosed with GA became ineligible to drive within a median time of 1.6 years [ 20 ].…”

“…GA also reduces one’s ability to recognise faces [ 32 , 33 ], and reading speed decreases as the GA lesion increases in size [ 31 , 34 ]. Critically, GA severely impacts a patient’s ability to drive, which limits their freedom to travel, reducing their independence [ 35 ]. Both AMD and GA increase the risk of depression and susceptibility to falls and injuries as a result of poor visual acuity [ 20 ].…”

Humanistic and Economic Burden of Geographic Atrophy: A Systematic Literature Review

“…Patients in the GA group had a significantly lower mean (standard deviation [SD]) NEI VFQ-25 composite score than those in the non-GA group (53.1 [19.05] vs 84.5 [6.55] points, respectively; P < 0.001). 22 Geographic atrophy affects multiple aspects of VRQOL and HRQOL. A US cross-sectional qualitative study explored the burden of illness of GA from the perspectives of patients (n = 8), caregivers (n = 6), and eye care professionals (n = 5).…”

“…3 In Europe, a retrospective chart review study investigated health-care resource use among patients in the UK, Germany, Ireland, and Canada with bilateral symptomatic GA versus a non-GA control group. 22 The annualized total cost, consisting of direct ophthalmic health-care resource use, was $2115 per patient with GA, mainly driven by diagnostic tests and procedures ($1278 per patient) (Figure 3). The annualized average direct total cost per patient with GA in this study ($2115) was comparable to direct vision-related medical costs reported for patients with neovascular AMD before anti-VEGF agents were approved in the UK ($3742).…”

The Use of Neuroprotective Agents in Treating Geographic Atrophy

“…Reading speed declines as a function of GA lesion size, location, and growth [50, 51], and GA negatively affects patients’ ability to recognize faces [52, 53]. GA also severely impacts patients’ ability to drive, limiting their freedom to travel [54]; 66.7% of patients become ineligible to drive within a median time of 1.6 years from their diagnosis [12]. AMD and GA also affect other aspects of patients’ quality of life, increasing the risk of depression as well as susceptibility to falls and injuries due to poor visual acuity [55, 56].…”