Burden of Treatment
by Dr Ainsley Morris, MDNZ Trustee and Ophthalmologist in Christchurch
’I don’t want to be a bother' – it’s a common theme amongst my patients with MD undergoing anti-VEGF treatment and one which I often discuss with them, as I know that better compliance with treatment will give better long term vision.
One of my patients is an accountant and he simply says he cannot afford NOT to be treated. So let’s consider AMD treatment as a return on investment – a Profit and Loss equation.
Treatment burden or Loss, is borne not only by the individual patient, but also by their whanau / caregivers, and society as a whole. Financial implications range from those on the patient (transport costs in attending appointments, insurance, lost productivity if employed) to their caregivers (taking leave to support and assist) and to society (productivity reductions, costs of medications and medical workforce).
The emotional burden is significant. Moderate AMD causes a 32% decrease in the patient’s quality of life – similar to severe angina or a fractured hip and very severe AMD results in a 60% decrease in quality of life, akin to end stage cancer or a severe stroke (1). Depression amongst patients with AMD is significant, with rates as high as 40% quoted (2).
Family and whanau are negatively impacted also. Societal costs such as loss of individual engagement, reliance on social services and reduced community participation are significant.
Let’s look at the Profit or benefits of treatment. Retaining or even improving sight, enables continued employment if applicable, giving financial value to the individual, their family and society via tax. Maintaining independence is vital for self-worth, mental health and community engagement. It reduces the need for support services and reliance on others.
A recent study in the US (3) modelled the financial costs of treatment versus the economic benefits. It found the improved vision associated with MD treatments, specifically antiVEGFs, provided greater value to the patient and society as a whole.
It is understood that treatment comes with burdens, but perseverance is key and the benefits outweigh the costs. As my patients puts it ‘’its an excellent return on the investment’.
1. The burden of ARMD: A value based medical analysis. Brown et al. Trans Am Ophthalmol Soc 2005;103:173-84.
2. Anxiety and Depression in patients with advanced macular depression: current perspectives. Cimvolli V et al Clin Ophthalmol 2016;10:55-63.
3. Econimic value for antiVEGF treatment for patients with wet ARMD in the US. Mulligan K et al JAMA Ophthalmol 2019; 138:40-47
