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Investing in Vision
Comparing the costs and benefitsof eliminating avoidableof eliminating avoidableblindness and visual impairment
Jeremy ThorpeMarty JovicPricewaterhouseCoopers
September 2012
IAPB Conference
Investing in Vision
Comparing the costs and benefitsof eliminating avoidableof eliminating avoidableblindness and visual impairment
1 Introduction
2
3
4
Methods
Results
Brief Discussion
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5 Conclusion
6 Questions and discussion
Agenda
Introduction 3
Methods
Results
Brief Discussion
6
10
15
2
Conclusion 19
Questions and discussion 21
Introduction
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3
The series of reports by PwC addressingthe costs and benefits of VISION 2020
The global initiative for the elimination of avoidable blindness
The Price of SightEstimates the globalcost of eliminatingavoidable blindnessand visualimpairment*
A benefitsframework foreliminating avoidableblindness and visualimpairment
The Value of SightEstimates the value ofbenefits associatedwith the effort toeliminate avoidableblindness and visualimpairment*
1 2 3
impairment*impairment*
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We would like to acknowledge thecontribution to various phases of thiswork by key individuals and from thefollowing NGOs:
The series of reports by PwC addressingthe costs and benefits of VISION 2020
The global initiative for the elimination of avoidable blindness
The Value of SightEstimates the value ofbenefits associatedwith the effort toeliminate avoidableblindness and visualimpairment*
Investing in VisionCompares the costto eliminate avoidableblindness with thecorrespondingbenefits
IAPB ConferencePresentation ofInvesting in Vision
4
impairment*benefits
4
* Developed in partnership with ThreeRivers Consulting
The benefits of eliminating avoidableblindness and visual impairment farexceed the investment required
Benefits
$8.9 per capita (indeveloping countries)developing countries)
Investment in primaryand secondary healthcare systems
Investment totreat thebacklog
Health
Social
Economic
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The benefits of eliminating avoidableblindness and visual impairment farexceed the investment required
CostsCosts
$2.2 per capita (indeveloping countries)
Economic
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Methods
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The Price of Sight
The Price of Sight reportused a health systems
Costing frameworksCosting framework for the primary/secondary health care sectors
used a health systemsapproach.
Estimates comprise:
• The annual recurrentcost of the existing eyehealth sector
• The investmentneeded to fill the‘gap’ to achieve the idealhealth system
Required recurrent expenditure =
Cost components comprise:
• Workforce costs, infrastructure costs,training costs and operational costs.
Recurrent expenditure of present state
Additional recurrent expenditure of anexpanded workforce and health system
Costing framework for the primary/secondary health care sectors
Costing framework for the backlog of avoidable blindness and visual impairment
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health system
• The investmentrequired to eliminatethe backlog(comprising prevalenceand incidence to 2020)
Operational cost of treatment/intervention for people currentlywith avoidable blindness
• Cataracts
• Glaucoma
• AMD
• Diabetic retinopathy
• Trachoma
• Onchocerciasis
• URE
Costing frameworksCosting framework for the primary/secondary health care sectors
Required recurrent expenditure =
Cost components comprise:
Workforce costs, infrastructure costs,training costs and operational costs.
One off additional requiredinvestment, based on the Vision 2020human resource ratios
• Investment required for workforcegrowth
• Investment required for associatedinfrastructure growth
• Investment required for associatedtraining growth
• Investment required for associatedgrowth in operational costs.
Total investmentrequired inprimary/secondary healthcare systems =building the
capacity to preventavoidable blindnessand to treat patientsat risk of avoidableblindness.
Recurrent expenditure of present state
Additional recurrent expenditure of anexpanded workforce and health system
Costing framework for the primary/secondary health care sectors
Costing framework for the backlog of avoidable blindness and visual impairment
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Operational cost of treatment/intervention for people currentlywith avoidable blindness
Diabetic retinopathy
Operational cost of treatment/intervention for people who willincur avoidable blindness between2011-2012
• Cataracts
• Glaucoma
• AMD
• Diabetic retinopathy
• Trachoma
• Onchocerciasis
• URE
Investmentrequired to treatthe backlog ofavoidableblindnesselimination
Benefits framework
The Value of Sight
The Value of Sight reportplaces a dollar value onbenefits of eliminatingbenefits of eliminatingavoidable blindness andvisual impairment and alsoidentifies a range of otherbenefits. The estimatecomprises:
• The benefits of treatingthe currentprevalence ofavoidable blindness andvisual impairment
Regionaladjustments
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visual impairment
• The benefit of treatingthe portion of newincidence that is notcurrently able to betreated under thecurrent health system
Benefits framework
Benefits quantified inmonetary terms are:
• Productivity benefit(persons aged 15-49 andtheir carers)
• Dead weight loss value(additional tax revenuegovernments raise tofund associated direct
Regionaladjustments
8
fund associated directhealth costs)
• Direct health systemsavings (averted healthcosts associated with co-morbidities)
This analysis: We have drawn on
Process to deliver this approach
This analysis:
• Quantifies, to the degreepossible, the benefits ofeliminating avoidableblindness and visualimpairment
• Compares to theinvestment required toeliminate avoidableblindness and visualimpairment.
We have drawn onmethodologies used in otheracademic studies.
This approach has beenreviewed by clinical andacademic experts to:
• Validate the approach/assumptions
• Find solutions to meetdata gaps
Through this work, we have
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impairment.
• Is on a global scale, toaddress the mission ofVISION 2020.
Through this work, we haveidentified priorities for futureresearch/data collection whichwill help refine futureestimates.
We have drawn on It differs to past studies, in
Process to deliver this approach
We have drawn onmethodologies used in otheracademic studies.
This approach has beenreviewed by clinical andacademic experts to:
the approach/assumptions
Find solutions to meetdata gaps
Through this work, we have
It differs to past studies, interms of:
• Geographic scope
• Disease scope (all causes ofavoidable blindness andvisual impairment)
• The question weanswer: the resultsdetermine that theinvestment is worthy,as the benefits far
9
Through this work, we haveidentified priorities for futureresearch/data collection whichwill help refine future
as the benefits farexceed costs.
Results
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Less than onethird of totalglobalinvestment isrequired in 300 Total Cost (308.4)
Summary of global cost by sector over 2011USD billions
required indevelopingcountries
Share of population (2010)
251.8
56.6
0
50
100
150
200
250
Investment in primary health caresystem
(47%)
(82%)
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16%
84%
Share of population (2010)
Developed Countries(High Income WorldBank) Cost (% oftotal)
Developing countries(all other regions)Cost (% of total)
Benefit Total Cost
Total
Total Cost (308.4)
Summary of global cost by sector over 2011-2020
4.713.8
56.6 58
12.9
Investment in primary health care Investment in secondary health caresystem
Investment to treat the backlog ofavoidable blindness and visual
impairment
DevelopedCountries (HighIncome WorldBank) Cost (% oftotal)
Developingcountries (all otherregions) Cost (% oftotal)(7%)
(93%)(18%)
Total Cost (62.7)
Total Cost (26.7)
(52%) (48%)
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Total Cost Developed Countries (High Income
World Bank) Cost (% of total)
Developing countries (all other
regions) Cost (% of total)
397.8 270.4 (68%) 127.4 (32%)
This is equal to an
investment of $2.20 a
person per year over 10 years
This is equal to an
investment of $5.80 a
person per year over 10 years
Almost half ofthe benefitvalue accruesto developingcountries
Economic
450.3450
500
(47%)
Total Benefit Value (856.4)
Summary of global benefit over 2011USD billions
countries 406.2
450.3
0
50
100
150
200
250
300
350
400
450
Productivity benefit to VI persons
Health
33
(47%)
(47%)
Share of population (2010)
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31
31.5
32
32.5
Benefit Total Benefit
Total
16%
84%
Share of population (2010)
Developed Countries(WHO Stratum A)Benefit (% of total)
Developing Countries(WHO Strata B-E)Benefit (% of total)
450.3 (53%)
Total Benefit Value (856.4)
Summary of global benefit over 2011-2020,
20.8
134.1
450.3
36.63.2
Productivity benefit to VI persons Productivity benefit to carers Deadweight loss benefit to VIpersons
DevelopedCountries (WHOStratum A) Benefit(% of total)
DevelopingCountries (WHOStrata B-E) Benefit(% of total)
32.5 Developed
(36%)(64%)
Total Benefit Value (57.4)
Total Benefit Value (137.3)
(98%)
(2%)
Total Benefit Value (64.3)
(51%)
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31.8
32.5
Averted falls benefit
DevelopedCountries (WHOStratum A) Benefit(% of total)
DevelopingCountries (WHOStrata B-E) Benefit(% of total)
Total Benefit
Value
Developed Countries (WHO Stratum
A) Benefit (% of total)
Developing Countries (WHO Strata
B-E) Benefit (% of total)
1,115.4 592.9 (53%) 522.6 (47%)
(49%)
(51%)
Globally, the benefits of eliminating avoidable blindness
and visual impairment outweigh the costs
In developing
Total benefits are estimated to be at least US$522.6 billionfrom 2011 to 2020, outweighing the additional investmentrequired (US$127.4 billion),
In developingcountries
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Total benefits are estimated to be at least US$592.9 billionfrom 2011 to 2020, outweighing the additional investmentrequired (US$270.4 billion),
the benefits of eliminating avoidable blindness
outweigh the costs by a multiple of
developing
2.8
Total benefits are estimated to be at least US$522.6 billionfrom 2011 to 2020, outweighing the additional investmentrequired (US$127.4 billion), a benefit cost ratio of 4.1.
developingcountries...
In developed
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Total benefits are estimated to be at least US$592.9 billionfrom 2011 to 2020, outweighing the additional investmentrequired (US$270.4 billion), a benefit cost ratio of 2.2.
In developedcountries...
Results are further enhanced by benefits not valued
in monetary form, such as
Life Years (DALYs)
DALYs (‘000s)
48,623
DALYs averted by WHO mortality strata (2004)Other social benefits,e.g.. increased genderequality andimproved socialnetworks. We suspectthat these benefits willbe substantiallyweighted towarddeveloping countriesbecause prevalence is
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Total 51,484
DevelopedCountries
DevelopingCountries
2,861because prevalence ishigher. The DALYsanalysis below affirmsthis notion.
Results are further enhanced by benefits not valued
in monetary form, such as Disability AdjustedLife Years (DALYs)
DALY share
94%
Population share
85%
DALYs averted by WHO mortality strata (2004)
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51,484 Total 100%
6%
DevelopedCountries
DevelopingCountries
Total 100%
16%
85%
DevelopedCountries
DevelopingCountries
Brief Discussion
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Social benefits are weighted towardsdeveloping countries
Benefits not quantified in monetary termsBenefits not quantified in monetary terms
Reduced ChildMorality
IncreasedPrimaryEducation
ImprovedIndependence,Self-esteem, &social networks
Improvedquality of life
Reducedextreme poverty
Increasedgenderequality
Social benefits will be realised predominantly in developing countries
$
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Social benefits are weighted towardsdeveloping countries
Increased
Education
Improvedquality of life
AssociatedDALYs avoidedhave beenquantified butnot included inour totalestimate ofbenefits...
Increased
developing countries
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benefits...
Estimates can besignificantlyimproved withgreater and moreconsistent data
Key areas for future research that would help to refine futureestimates of costs
consistent datacollection in thesector
Better collectionand collation ofdata
Expand datacollection in a sampleof countries
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Key areas for future research that would help to refine futurecosts include:
Focus data collectionBetter collectionand collation of
Focus data collectionon diseases thatimpact the largestpopulations
collection in a sample
Better estimation oftraining andinfrastructure costs
Identify a detailed setof KPIs linked toexisting Vision2020KPIs
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Future researchwill help toovercome the datalimitationsencountered,
Key areas for future research that would help to refine futureestimates of benefits
Prevalence15-65 yrsencountered,
strengthening theanalysis of costsand benefits
15-65 yrs
Current expenditureon eye health servicesby country
Despite the data limitations, sensitivity analysis showsthat the benefits of eliminating avoidable blindness andvisual impairment substantially outweigh the costs
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Key areas for future research that would help to refine futurebenefits include:
Prevalence65 yrs
Average income andemployment forblind & visually65 yrs blind & visuallyimpaired indeveloping world
Impact of caringon productivity
Current expenditureon eye health services
Current workforce inrespect to eye healthand primary care bycountry
Despite the data limitations, sensitivity analysis showsthat the benefits of eliminating avoidable blindness andvisual impairment substantially outweigh the costs
on productivity
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Conclusion
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5
The series of reports by PwC is the first analysis whichexamines the investment required to eliminate avoidableblindness and visual impairment, and the correspondingbenefits accrued to individuals, carers, the community and
Eliminating avoidableimpairment is
benefits accrued to individuals, carers, the community andthe economy. The key findings are:
Globally, the benefitsof eliminatingavoidable blindnessand visualimpairment far
If developingcountries areexamined alone, the
Developing countriesbear the majority ofthe burden ofavoidable blindnessand visual
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impairment farexceed theinvestment requiredby a multiple of 2.8times the cost.
examined alone, thebenefits outweigh thecosts by a multiple of4.1.
and visualimpairment, and arealso expected toreceive the majorityof the benefit ifeliminated.
The series of reports by PwC is the first analysis whichexamines the investment required to eliminate avoidableblindness and visual impairment, and the correspondingbenefits accrued to individuals, carers, the community and
Eliminating avoidable blindness and visualimpairment is a worthy investment
benefits accrued to individuals, carers, the community andthe economy. The key findings are:
There is an identifiedneed for moreresearch in key areaswhich will greatlystrengthen future
If developingcountries areexamined alone, the
The total dollar valueof the benefitsquantified isunderestimatedgiven it does notinclude the quality oflife or social benefits
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strengthen futureestimates andanalysis.
examined alone, thebenefits outweigh thecosts by a multiple of
life or social benefitsidentified totranspire from theelimination ofavoidable blindnessand visualimpairment.
Questions and discussion
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Questions and discussion
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pwc.com.au
Jeremy ThorpePartner, AnalyticsPartner, [email protected]
Marty JovicDirector, Health Economics and [email protected]
© 2012 PricewaterhouseCoopers. All rights reserved.PwC refers to the Australian member firm, and may sometimes refer to the PwC network.Each member firm is a separate legal entity. Please see www.pwc.com/structure for further details.
Liability is limited by the Accountant's Scheme under the Professional Standards Act 1994 (NSW)
Director, Health Economics and Policy
for further details.
Liability is limited by the Accountant's Scheme under the Professional Standards Act 1994 (NSW)
