Economic Burden of Age-Related Macular Degeneration and Diabetic Macular Edema in Slovakia: a Cost-of-illness Analysis

Abstract Background Visual impairment and blindness significantly affect patient health and socioeconomic status. Among the main causes of vision impairment are Age-related Macular Degeneration (AMD) in both wet (neovascular) and dry (non-exudative) forms, and Diabetic Macular Edema (DME). These conditions represent major healthcare burdens due to associated medical and societal costs. Objective The objective of the present study was to evaluate the economic burden of wet and dry AMD and DME in Slovakia, emphasizing direct medical and non-medical costs, as well as indirect costs due to lost productivity. Methods A prevalence-based "cost-of-illness" strategy was applied retrospectively for the year 2021 from a societal perspective. Data were collected using structured questionnaires from patients and ophthalmologists, Slovak healthcare databases (National Centre for Health Information—NCZI), health insurance records, and patient advocacy groups. Bottom-up costing was applied to direct healthcare costs, establishing healthcare services and unit costs, whereas indirect costs were ascertained by the human capital approach. Non-medical costs were also extrapolated from patient surveys and consultant interviews. Results For the year 2021, the total annual economic burden for wet AMD was approximately €105.7 million and for DME was €45.1 million in Slovakia. The total annual cost per patient was €5,281 for wet AMD and €4,049 for DME. Direct healthcare costs represented over half (54%) of wet AMD costs, predominantly due to pharmacotherapy (€23.9 million) and hospital/emergency care (€13.7 million). For DME, direct care consisted of approximately 36% (€16.0 million), with pharmacotherapy (€6.2 million) and treatment monitoring and management (€2.5 million each) as the leaders. Non-medical direct spending (transport, home adaptation) was negligible for both conditions (13% wet AMD, 2% DME). Indirect costs like absenteeism, presenteeism, and formal care accounted for 33% of wet AMD and over 60% of the cost of DME. Specifically, presenteeism was the largest share in indirect costs in DME (€16.1 million). Conclusion Wet AMD and DME impose tremendous economic loads on the Slovak healthcare system and society, which are predominantly driven by direct medical and indirect productivity costs. Effective prevention, early diagnosis, and optimal management strategies would significantly reduce these economic loads and improve patient outcomes.