pwc.com.au. Investing in Vision. Comparing the costs and bene of eliminating
avoidable blindness and visual impairm. Jeremy Thorpe. Marty Jovic.
pwc.com.au
Investing in Vision Comparing the costs and benefits of eliminating avoidable blindness and visual impairment Jeremy Thorpe Marty Jovic PricewaterhouseCoopers September 2012 IAPB Conference
Agenda
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Introduction
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2
Methods
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3
Results
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4
Brief Discussion
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5
Conclusion
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Questions and discussion
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Introduction
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The series of reports by PwC addressing the costs and benefits of VISION 2020
The global initiative for the elimination of avoidable blindness 1
2 The Price of Sight Estimates the global cost of eliminating avoidable blindness and visual impairment*
We would like to acknowledge the contribution to various phases of this work by key individuals and from the following NGOs: PwC
A benefits framework for eliminating avoidable blindness and visual impairment
3 The Value of Sight Estimates the value of benefits associated with the effort to eliminate avoidable blindness and visual impairment*
4 Investing in Vision Compares the cost to eliminate avoidable blindness with the corresponding benefits
IAPB Conference Presentation of Investing in Vision
* Developed in partnership with Three Rivers Consulting 4
Benefits $8.9 per capita (in developing countries)
Investment to treat the backlog Investment in primary and secondary health care systems
The benefits of eliminating avoidable blindness and visual impairment far exceed the investment required Costs $2.2 per capita (in developing countries)
Social Health
Economic
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Methods
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The Price of Sight
The Price of Sight report used a health systems approach.
Costing frameworks Costing framework for the primary/secondary health care sectors Required recurrent expenditure = Recurrent expenditure of present state
Estimates comprise: • The annual recurrent cost of the existing eye health sector • The investment needed to fill the ‘gap’ to achieve the ideal health system • The investment required to eliminate the backlog (comprising prevalence and incidence to 2020)
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Additional recurrent expenditure of an expanded workforce and health system
Cost components comprise: • Workforce costs, infrastructure costs, training costs and operational costs.
One off additional required investment, based on the Vision 2020 human resource ratios • Investment required for workforce growth • Investment required for associated infrastructure growth • Investment required for associated training growth • Investment required for associated growth in operational costs.
Total investment required in primary/ secondary health care systems = building the capacity to prevent avoidable blindness and to treat patients at risk of avoidable blindness.
Costing framework for the backlog of avoidable blindness and visual impairment Operational cost of treatment/ intervention for people currently with avoidable blindness • • • • • • •
Cataracts Glaucoma AMD Diabetic retinopathy Trachoma Onchocerciasis URE
Operational cost of treatment/ intervention for people who will incur avoidable blindness between 2011-2012 • Cataracts • Glaucoma • AMD • Diabetic retinopathy • Trachoma • Onchocerciasis • URE
Investment required to treat the backlog of avoidable blindness elimination
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The Value of Sight The Value of Sight report places a dollar value on benefits of eliminating avoidable blindness and visual impairment and also identifies a range of other benefits. The estimate comprises: • The benefits of treating the current prevalence of avoidable blindness and visual impairment • The benefit of treating the portion of new incidence that is not currently able to be treated under the current health system PwC
Benefits framework Benefits quantified in monetary terms are: • Productivity benefit (persons aged 15-49 and their carers) Regional adjustments
• Dead weight loss value (additional tax revenue governments raise to fund associated direct health costs) • Direct health system savings (averted health costs associated with comorbidities)
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Process to deliver this approach
This analysis: • Quantifies, to the degree possible, the benefits of eliminating avoidable blindness and visual impairment • Compares to the investment required to eliminate avoidable blindness and visual impairment. • Is on a global scale, to address the mission of VISION 2020.
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We have drawn on methodologies used in other academic studies. This approach has been reviewed by clinical and academic experts to: • Validate the approach/ assumptions • Find solutions to meet data gaps Through this work, we have identified priorities for future research/data collection which will help refine future estimates.
It differs to past studies, in terms of: • Geographic scope • Disease scope (all causes of avoidable blindness and visual impairment) • The question we answer: the results determine that the investment is worthy, as the benefits far exceed costs.
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Results
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Less than one third of total global investment is required in developing countries
Summary of global cost by sector over 2011-2020 2011 USD billions
300
Total Cost (308.4) 251.8 (82%)
250 200
(47%)
Developed Countries (High Income World Bank) Cost (% of total)
150 Total Cost (62.7)
100
58 (93%)
56.6 (18%) 50 4.7 (7%)
0
Total Cost (26.7) 13.8 (52%) 12.9 (48%)
Developing countries (all other regions) Cost (% of total)
Investment in primary health care Investment in secondary health care Investment to treat the backlog of system system avoidable blindness and visual impairment
Share of population (2010)
16%
84%
This is equal to an investment of $5.80 a person per year over 10 years
Developed Countries (High Income World Bank) Cost (% of total) Developing countries (all other regions) Cost (% of total)
Benefit Total
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This is equal to an investment of $2.20 a person per year over 10 years
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%)
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Almost half of the benefit value accrues to developing countries
Summary of global benefit over 2011-2020, 2011 USD billions Economic Total Benefit Value (856.4) 500 406.2 (47%)
450
450.3 (53%)
400 350 300
(47%)
250
Total Benefit Value (137.3)
200
Total Benefit Value (57.4)
150 100 50
20.8 (36%)
134.1 (98%)
36.6 (64%)
3.2 (2%)
0 Productivity benefit to VI persons
Productivity benefit to carers
Developed Countries (WHO Stratum A) Benefit (% of total)
Deadweight loss benefit to VI persons
Developing Countries (WHO Strata B-E) Benefit (% of total)
Health Share of population (2010)
Total Benefit Value (64.3)
33
32.5 (51%)
32.5 31.8 (49%)
32
16%
84%
Developed Countries (WHO Stratum A) Benefit (% of total)
Developing Countries (WHO Strata B-E) Benefit (% of total)
31 Averted falls benefit
Total
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Developing Countries (WHO Strata B-E) Benefit (% of total)
31.5
Benefit
Developed Countries (WHO Stratum A) 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%)
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Globally, the benefits of eliminating avoidable blindness and visual impairment outweigh the costs by a multiple of
2.8
In developing countries countries... Total benefits are estimated to be at least US$522.6 billion from 2011 to 2020, outweighing the additional investment required (US$127.4 billion), a benefit cost ratio of 4.1.
In developed countries... Total benefits are estimated to be at least US$592.9 billion from 2011 to 2020, outweighing the additional investment required (US$270.4 billion), a benefit cost ratio of 2.2.
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Results are further enhanced by benefits not valued in monetary form, such as Disability Adjusted
Life Years (DALYs)
Other social benefits, e.g.. increased gender equality and improved social networks. We suspect that these benefits will be substantially weighted toward developing countries because prevalence is higher. The DALYs analysis below affirms this notion.
DALYs averted by WHO mortality strata (2004) DALYs (‘000s)
Population share
48,623
94%
85%
2,861 6% Developed Developing Countries Countries
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DALY share
51,484
16%
Developed Developing Countries Countries
Total
100%
Developed Developing Countries Countries
Total
100% 14
Brief Discussion
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Social benefits are weighted towards developing countries
Benefits not quantified in monetary terms Reduced Child Morality
Increased Primary Education
Improved Independence, Self-esteem, & social networks
Improved quality of life
Reduced extreme poverty
Increased gender equality
$
Associated DALYs avoided have been quantified but not included in our total estimate of benefits...
Social benefits will be realised predominantly in developing countries
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Estimates can be significantly improved with greater and more consistent data collection in the sector
Key areas for future research that would help to refine future estimates of costs include:
Better collection and collation of data
Expand data collection in a sample of countries
Focus data collection on diseases that impact the largest populations
Better estimation of training and infrastructure costs
Identify a detailed set of KPIs linked to existing Vision2020 KPIs
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Future research will help to overcome the data limitations encountered, strengthening the analysis of costs and benefits
Key areas for future research that would help to refine future estimates of benefits include:
Prevalence 15-65 65 yrs
Current expenditure on eye health services by country
Average income and employment for blind & visually impaired in developing world
Current workforce in respect to eye health and primary care by country
Impact of caring on productivity
Despite the data limitations, sensitivity analysis shows that the benefits of eliminating avoidable blindness and visual impairment substantially outweigh the costs PwC
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Conclusion
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Eliminating avoidable blindness and visual impairment is a worthy investment The series of reports by PwC is the first analysis which examines the investment required to eliminate avoidable blindness and visual impairment, and the corresponding benefits accrued to individuals, carers, the community and the economy. The key findings are:
Developing countries bear the majority of the burden of avoidable blindness and visual impairment, and are also expected to receive the majority of the benefit if eliminated.
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Globally, the benefits of eliminating avoidable blindness and visual impairment far exceed the investment required by a multiple of 2.8 times the cost.
If developing countries are examined alone, the benefits outweigh the costs by a multiple of 4.1.
The total dollar value of the benefits quantified is underestimated given it does not include the quality of life or social benefits identified to transpire from the elimination of avoidable blindness and visual impairment.
There is an identified need for more research in key areas which will greatly strengthen future estimates and analysis.
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Questions and discussion
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pwc.com.au
Jeremy Thorpe Partner, Analytics
[email protected] Marty Jovic Director, Health Economics and Policy
[email protected]
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