Supplementary Material

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1 1 ORIGINAL RESEARCH ARTICLE Pharmacoeconomics 2008; 26 (1): Supplementary Material /08/ /$48.00/ Adis Data Information BV. All rights reserved. Economic Burden of Bilateral Neovascular Age-Related Macular Degeneration Multi-Country Observational Study Alan F. Cruess, 1 Gergana Zlateva, 2 Xiao Xu, 3 Gisèle Soubrane, 4 Daniel Pauleikhoff, 5 Andrew Lotery, 6 Jordi Mones, 7 Ronald Buggage, 2 Caroline Schaefer, 3 Tyler Knight 3 and Thomas F. Goss 3 1 Department of Ophthalmology and Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada 2 Pfizer Ophthalmics, New York, New York, USA 3 Covance Market Access Services Inc., Gaithersburg, Maryland, USA 4 Department of Ophthalmology, University Paris XII, Centre Hospitalier Intercommunal de Créteil, Créteil, France 5 Augenarztpraxis des St Franziskus-Hospital, Münster, Germany 6 Southhampton Eye Unit, University of Southampton, Southampton, England 7 Centro Médico Teknon, Instituto de Microcirugia Ocular de Barcelona, Barcelona, Spain Supplementary Material This supplementary material contains the tables referred to in the full version of this article, which can be found at

2 Table A1: Demographic and clinical characteristics of the control subjects by country a Characteristic Canada (n=99) France (n=92) Germany (n=93) Age, years Mean (SD) (8.51) (7.58) (8.42) (8.17) (8.53) Median (range) 59 (50 87) 68 (52 80) 64 (50 85) 60 (50 88) 65 (50 86) Gender, n (%) Male 43 (43.4) 44 (47.8) 39 (41.9) 30 (31.3) 46 (50.5) Female 54 (54.5) 48 (52.2) 54 (58.1) 66 (68.7) 45 (49.5) Race, n (%) Caucasian 88 (88.9) 71 (77.2) 92 (98.9) 95 (99.0) 76 (83.5) Black 4 (4.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (1.1) Asian 2 (2.0) 0 (0.0) 0 (0.0) 0 (0.0) 4 (4.4) Other 2 (2.0) 16 (17.4) 0 (0.0) 0 (0.0) 7 (7.7) Current best-corrected visual acuity (LogMAR) in better-seeing eye Mean (SD) 0.09 (0.70) 0.05 (0.82) 0.02 (0.77) 0.06 (0.74) 0.04 (0.62) Median (range) 0.00 ( ) 0.00 ( ) 0.00 ( ) Spain (n=96) 0.00 ( ) UK (n=91) 0.00 ( ) Having comorbid diseases, n (%) b 76 (76.8) 88 (95.7) 84 (90.3) 67 (69.8) 77 (84.6) Total number of comorbid diseases c Mean (SD) 2.11 (1.29) 2.25 (1.15) 2.50 (1.49) 2.09 (1.41) 1.84 (1.16) Median (range) 2 (1-8) 2 (1-6) 2 (1-8) 2 (1-6) 2 (1-7) Total number of months under current general practitioner s care Mean (SD) (66.88) (101.66) (183.10) (36.30) (106.88) Median (range) 85 (0 252) (18 390) 98 (1 732) 41 (0 240) 156 (3 600) a Some numbers vary because of missing data. b Comorbid disease included diabetes, glaucoma, cataract, anxiety disorder, depression, cancer, asthma, chronic obstructive pulmonary disease, arthritis and rheumatism, headache (migraine: cluster), chronic neck or back pain, other chronic pain, heart disease, stroke, sleep disturbance, substance use disorder, and other. c Among subjects with any comorbid disease. SD = standard deviation; UK = United Kingdom. 2

3 Page 3 of 14 Table A2. Health resource utilisation by control subjects in the preceding 12 months Health resource utilisation Canada (n=99 ) France (n=92) Germany (n=93) Any accident, n (%) 17 (17.2) 4 (4.3) 7 (7.5) 16 (16.7) 18 (19.8) Falls, n (%) 8 (8.1) 3 (3.3) 4 (4.3) 12 (12.5) 12 (13.2) Number of falls, mean (SD) 2.13 (1.13) 2.00 (1.00) 1.50 (0.58) 3.58 (5.58) 1.17 (0.39) Sought medical treatment, n (%) 4 (4.0) 1 (1.1) 2 (2.2) 6 (6.3) 9 (9.9) Fall-related fracture, n (%) 0 (0.0) 2 (2.2) 1 (1.1) 2 (2.1) 2 (2.2) Other accidents, n (%) 7 (7.1) 1 (1.1) 2 (2.2) 0 (0.0) 9 (9.9) Number of other accidents, mean (SD) 2.14 (1.46) NR 1.50 (0.71) NA 2.22 (1.72) Sought medical treatment, n (%) 1 (1.0) 0 (0.0) 0 (0.0) NA 3 (3.3) Treatment for depression/anxiety, n (%) 16 (16.2) 20 (21.7) 12 (12.9) 20 (20.8) 9 (9.9) Number of months on medication, mean (SD) 7.23 (5.04) 7.21 (4.66) 7.73 (4.47) 9.38 (4.05) 7.06 (4.89) Visited ophthalmologist/ optometrist, n (%) 55 (55.6) 43 (46.7) 60 (64.5) 62 (64.6) 46 (50.5) Visited ophthalmologist 26 (26.3) 39 (42.4) 49 (52.7) 57 (59.4) 14 (15.4) Visited optometrist 36 (36.4) 10 (10.9) 37 (39.8) 22 (22.9) 37 (40.7) Changed eye glasses or contact lenses, n (%) 25 (25.3) 28 (30.4) 17 (18.3) 25 (26.0) 33 (36.3) Eye glasses changed 25 (25.3) 28 (30.4) 17 (18.3) 25 (26.0) 33 (36.3) Contact lenses changed 1 (1.0) 0 (0.0) 0 (0.0) 1 (1.0) 0 (0.0) Number of evaluations by general practitioners, mean (SD) 6.28 (5.40) (4.11) (16.40) 6.18 (7.90) 6.73 (4.43) Non-vision-related medical treatment, n (%) 78 (78.8) 87 (94.6) 90 (96.8) 83 (86.5) 86 (94.5) Living situation, n (%) Lived with spouse or family member 72 (72.7) 75 (81.5) 75 (80.6) 83 (86.5) 71 (78.0) Lived alone 27 (27.3) 18 (19.6) 18 (19.4) 12 (12.5) 19 (20.9) Lived in private assisted-living facility (part-time care) 2 (2.0) 0 (0.0) 1 (1.1) 0 (0.0) 1 (1.1) Lived in government-sponsored assisted-living facility (part-time care) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Lived in a private nursing home (full-time care) 0 (0.0) 1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) Lived in a government-sponsored nursing home (full-time care) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Received assistance for daily activities, n (%) 9 (9.1) 6 (6.5) 2 (2.2) 8 (8.3) 6 (6.6) Received home care 4 (4.0) 6 (6.5) 2 (2.2) 8 (8.3) 2 (2.2) Received self care 4 (4.0) 1 (1.1) 0 (0.0) 0 (0.0) 0 (0.0) Received transportation for healthcare 5 (5.1) 3 (3.3) 0 (0.0) 3 (3.1) 2 (2.2) Received transportation other than for healthcare 2 (2.0) 2 (2.2) 0 (0.0) 2 (2.1) 1 (1.1) Spain (n=96) UK (n=91)

4 Page 4 of 14 Health resource utilisation Canada (n=99 ) France (n=92) Germany (n=93) Received assistance with administrative tasks 1 (1.0) 0 (0.0) 0 (0.0) 1 (1.0) 0 (0.0) Received assistance with leisure activities 2 (2.0) 0 (0.0) 0 (0.0) 2 (2.1) 0 (0.0) NA = not applicable; NR = not reported by controls; SD = standard deviation; UK = United Kingdom. Spain (n=96) UK (n=91)

5 Page 5 of 14 Table A3. Mean (95% confidence interval) Cost for each HRU category between unilateral and bilateral AMD patients Country=Canada Total Fall-Related Costs ( , ) (-1.86, ) Hospital emergency room (-3.77, 8.42) (0.17, 11.15) Primary care physician office (-2.98, 14.23) (-3.19, 12.31) Specialists (-5.72, 33.84) (-14.01, 21.61) Admitted into the hospital ( , ) (-7.92, ) Total Other Accidents-Related Costs (-2.83, 14.34) (-5.40, 10.07) Hospital emergency room (0.00, 0.00) (0.00, 0.00) n/a Primary care physician office (-2.83, 14.34) (-5.40, 10.07) Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Depression/Anxiety Treatment- Related Costs (20.34, 73.68) (-14.49, 33.55) Prescription medication cost (6.97, 26.03) (-3.72, 13.45) Total Physician-related costs (11.30, 49.72) (-12.63, 21.96) Primary care physician/general practitioner (9.47, 39.44) (-8.83, 18.16) Specialist/Psychiatrist (-1.34, 9.33) (-4.80, 4.80) Other specialist (-0.69, 4.79) (-2.47, 2.47) Total Living Situation-Related Costs ( , ) ( , ) Government-sponsored assisted living facility ( , ) ( , ) Government-sponsored nursing home (0.00, 0.00) (0.00, 0.00) n/a Total Costs of Assistance for Daily Activities Received only) (41.54, ) ( , ) Home Care ( , ) ( , ) Self Care (-76.19, ) (-32.48, ) Transportation for Healthcare (72.24, ) ( , ) Transportation Other Than for Healthcare (27.60, ) ( , ) Assistance with Administrative Tasks (-21.85, ) ( , ) Assistance with Leisure Activities (0.00, 0.00) (0.00, 0.00) n/a Total Costs for Ophthalmologist/ Optometrist Visits (90.05, ) (47.00, )

6 Page 6 of 14 Ophthalmologist (45.36, ) (19.14, 81.10) Optometrist (31.09, 70.83) (15.61, 51.39) Total Eye Glasses or Contact Lenses- Related Costs (40.59, 87.79) (-0.44, 42.07) Eye Glasses (40.59, 87.79) (-0.44, 42.07) Contact lenses (0.00, 0.00) (0.00, 0.00) n/a Total Non-Vision Related Medical Treatment-Related Costs (807.76, ) ( , ) Hospital emergency room (16.23, 62.92) (14.85, 56.88) Primary care physician office (103.90, ) (131.22, ) Specialists (40.80, ) (1.53, ) Admitted into the hospital (557.72, ) ( , ) Total Retinal Specialist Evaluation Costs (218.47, ) (191.64, ) Direct Vision-Related Medical Cost ( , ) ( , ) Direct Non-Vision Related Medical Cost (849.41, ) ( , ) Direct Non-Medical Related Cost (491.97, ) ( , ) Total Patient Cost ( , ) ( , )

7 Page 7 of 14 Table A4. Mean (95% confidence interval) Cost for each HRU category between unilateral and bilateral AMD patients Country=France Total Fall-Related Costs ( , ) (-31.19, ) Hospital emergency room (-1.33, 1.33) (0.00, 2.58) Primary care physician office (-6.72, 9.58) (-2.10, 13.65) Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital ( , ) (-29.72, ) Total Other Accidents-Related Costs (-0.66, 0.66) (-0.19, 1.08) Hospital emergency room (0.00, 0.00) (0.00, 0.00) n/a Primary care physician office (-0.66, 0.66) (-0.19, 1.08) Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Depression/Anxiety Treatment- Related Costs (26.77, ) (5.42, 78.42) Prescription medication cost (14.39, 58.53) (3.71, 46.35) Total Physician-related costs (9.72, 46.47) (-0.86, 34.64) Primary care physician/general practitioner (8.76, 41.72) (-5.26, 26.59) Specialist/Psychiatrist (-5.12, 8.92) (-0.56, 13.00) Other specialist (-0.36, 2.27) (-1.27, 1.27) Total Living Situation-Related Costs (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored assisted living facility (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored nursing home (0.00, 0.00) (0.00, 0.00) n/a Total Costs of Assistance for Daily Activities Received only) (890.68, ) (897.57, ) Home Care (47.78, ) (347.06, ) Self Care (71.94, ) ( , ) Transportation for Healthcare (14.80, ) (-15.28, ) Transportation Other Than for Healthcare ( , ) ( , ) Assistance with Administrative Tasks (-51.95, ) (-13.32, ) Assistance with Leisure Activities (0.00, 0.00) (0.00, 0.00) n/a Total Costs for Ophthalmologist/ Optometrist Visits (52.64, ) (-0.64, 83.98)

8 Page 8 of 14 Ophthalmologist (52.64, ) (-0.64, 83.98) Optometrist (0.00, 0.00) (0.00, 0.00) n/a Total Eye Glasses or Contact Lenses- Related Costs (12.80, 74.63) (5.83, 65.57) Eye Glasses (12.80, 74.63) (5.83, 65.57) Contact lenses (0.00, 0.00) (0.00, 0.00) n/a Total Non-Vision Related Medical Treatment-Related Costs (-51.65, ) (26.91, ) Hospital emergency room (-6.79, 26.13) (4.07, 35.88) Primary care physician office (69.12, ) (66.49, ) Specialists (5.60, 38.44) (20.25, 51.97) Admitted into the hospital ( , ) (-93.45, ) Total Retinal Specialist Evaluation Costs (93.65, ) (77.36, ) Direct Vision-Related Medical Cost ( , ) ( , ) Direct Non-Vision Related Medical Cost (10.37, ) (141.55, ) Direct Non-Medical Related Cost (890.68, ) (897.57, ) Total Patient Cost ( , ) ( , )

9 Page 9 of 14 Table A5. Mean (95% confidence interval) Cost for each HRU category between unilateral and bilateral AMD patients Country=Germany Total Fall-Related Costs (-0.81, 19.92) (-8.44, 16.45) Hospital emergency room (-2.14, 16.74) (-9.23, 13.44) Primary care physician office (-0.85, 4.05) (-2.94, 2.94) Specialists (-1.59, 2.91) (-0.80, 4.60) Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Other Accidents-Related Costs (0.00, 0.00) (0.00, 0.00) n/a Hospital emergency room (0.00, 0.00) (0.00, 0.00) n/a Primary care physician office (0.00, 0.00) (0.00, 0.00) n/a Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Depression/Anxiety Treatment- Related Costs (-28.55, 61.48) (-9.88, 98.20) Prescription medication cost (0.26, 17.96) (-10.62, 10.62) Total Physician-related costs (-35.95, 50.66) (-7.83, 96.15) Primary care physician/general practitioner (-3.43, 11.28) (-4.20, 13.46) Specialist/Psychiatrist (-38.72, 45.57) (-11.07, 90.13) Other specialist (0.00, 0.00) (0.00, 0.00) n/a Total Living Situation-Related Costs (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored assisted living facility (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored nursing home (0.00, 0.00) (0.00, 0.00) n/a Total Costs of Assistance for Daily Activities Received only) ( , ) ( , ) Home Care ( , ) ( , ) Self Care ( , ) ( , ) Transportation for Healthcare (-3.50, ) (-35.97, )

10 Page 10 of 14 Transportation Other Than for Healthcare (-20.12, 95.81) (-69.58, 69.58) Assistance with Administrative Tasks ( , ) (17.03, ) Assistance with Leisure Activities (0.00, 0.00) (0.00, 0.00) n/a Total Costs for Ophthalmologist/ Optometrist Visits (42.53, 82.40) (32.57, 80.43) Ophthalmologist (42.53, 82.40) (32.57, 80.43) Optometrist (0.00, 0.00) (0.00, 0.00) n/a Total Eye Glasses or Contact Lenses- Related Costs (0.00, 0.00) (0.00, 0.00) n/a Eye Glasses (0.00, 0.00) (0.00, 0.00) n/a Contact lenses (0.00, 0.00) (0.00, 0.00) n/a Total Non-Vision Related Medical Treatment-Related Costs (589.38, ) (420.26, ) Hospital emergency room (9.72, 39.91) (-9.70, 26.53) Primary care physician office (98.78, ) (53.41, ) Specialists (32.84, 69.99) (21.40, 66.00) Admitted into the hospital (403.04, ) (301.13, ) Total Retinal Specialist Evaluation Costs (97.04, ) (111.15, ) Direct Vision-Related Medical Cost ( , ) ( , ) Direct Non-Vision Related Medical Cost (614.47, ) (467.30, ) Direct Non-Medical Related Cost ( , ) ( , ) Total Patient Cost ( , ) ( , )

11 Page 11 of 14 Table A6. Mean (95% confidence interval) Cost for each HRU category between unilateral and bilateral AMD patients Country=Spain Total Fall-Related Costs ( , ) (-79.41, ) Hospital emergency room (-2.91, 26.24) (0.15, 24.75) Primary care physician office (-2.80, 5.90) (-0.36, 6.97) Specialists (-9.99, 20.40) (-4.36, 21.28) Admitted into the hospital ( , ) ( , ) Total Other Accidents-Related Costs (0.00, 0.00) (0.00, 0.00) n/a Hospital emergency room (0.00, 0.00) (0.00, 0.00) n/a Primary care physician office (0.00, 0.00) (0.00, 0.00) n/a Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Depression/Anxiety Treatment- Related Costs (5.97, ) (-0.73, ) Prescription medication cost (22.89, 84.11) (11.47, 63.11) Total Physician-related costs (-30.90, ) (-23.98, ) Primary care physician/general practitioner (0.34, 21.34) (-2.98, 14.73) Specialist/Psychiatrist (-3.62, ) (-32.61, 61.27) Other specialist (-57.42, 57.42) (-13.53, 83.34) Total Living Situation-Related Costs (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored assisted living facility (0.00, 0.00) (0.00, 0.00) n/a Government-sponsored nursing home (0.00, 0.00) (0.00, 0.00) n/a Total Costs of Assistance for Daily Activities Received only) ( , ) (339.94, ) Home Care ( , ) (188.75, ) Self Care (-59.93, 76.48) (-4.53, ) Transportation for Healthcare ( , ) (-6.10, ) Transportation Other Than for Healthcare ( , ) (-30.17, ) Assistance with Administrative Tasks (-41.23, 41.23) (12.34, 81.89) Assistance with Leisure Activities (-58.87, ) ( , ) Total Costs for Ophthalmologist/ Optometrist Visits (225.03, ) (60.38, )

12 Page 12 of 14 Ophthalmologist (198.41, ) (63.68, ) Optometrist (12.50, 62.04) (-15.21, 26.58) Total Eye Glasses or Contact Lenses- Related Costs (-10.33, 73.58) (41.53, ) Eye Glasses (-14.65, 68.70) (41.77, ) Contact lenses (-1.28, 10.47) (-4.96, 4.96) Total Non-Vision Related Medical Treatment-Related Costs (-82.49, ) (105.67, ) Hospital emergency room (5.26, 53.07) (25.49, 65.81) Primary care physician office (25.54, 70.48) (36.51, 74.42) Specialists (19.95, 46.95) (10.82, 33.60) Admitted into the hospital ( , ) (-4.79, ) Total Retinal Specialist Evaluation Costs (376.43, ) (308.73, ) Direct Vision-Related Medical Cost ( , ) ( , ) Direct Non-Vision Related Medical Cost (-0.79, ) (237.07, ) Direct Non-Medical Related Cost (183.08, ) (-24.39, ) Total Patient Cost ( , ) ( , )

13 Page 13 of 14 Table A7. Mean (95% confidence interval) Cost for each HRU category between unilateral and bilateral AMD patients Country=United Kingdom Total Fall-Related Costs (-16.95, ) (-69.15, 71.73) Hospital emergency room (-0.24, 7.29) (-4.49, 4.49) Primary care physician office (-0.73, 1.64) (-0.12, 2.69) Specialists (0.00, 0.00) (0.00, 0.00) n/a Admitted into the hospital (-20.23, 96.63) (-69.61, 69.61) Total Other Accidents-Related Costs (-5.98, 5.98) (0.58, 14.83) Hospital emergency room (-4.14, 4.14) (0.62, 10.49) Primary care physician office (-0.26, 0.26) (-0.07, 0.55) Specialists (-2.05, 2.05) (-0.53, 4.35) Admitted into the hospital (0.00, 0.00) (0.00, 0.00) n/a Total Depression/Anxiety Treatment- Related Costs (-65.53, 69.82) (40.02, ) Prescription medication cost (-11.93, 14.18) (11.60, 42.69) Total Physician-related costs (-57.43, 59.47) (23.86, ) Primary care physician/general practitioner (-1.27, 3.32) (-0.32, 5.15) Specialist/Psychiatrist (-58.55, 58.55) (21.32, ) Other specialist (0.00, 0.00) (0.00, 0.00) n/a Total Living Situation-Related Costs ( , ) ( , ) Government-sponsored assisted living facility ( , ) ( , ) Government-sponsored nursing home (0.00, 0.00) (0.00, 0.00) n/a Total Costs of Assistance for Daily Activities Received only) (264.80, ) (341.14, ) Home Care (-45.66, ) (124.45, ) Self Care (0.00, 0.00) (0.00, 0.00) n/a Transportation for Healthcare (-28.68, ) ( , ) Transportation Other Than for Healthcare (-43.83, ) ( , ) Assistance with Administrative Tasks ( , ) (-52.15, ) Assistance with Leisure Activities (-44.72, 44.72) (3.43, ) Total Costs for Ophthalmologist/ Optometrist Visits (68.45, ) (43.45, )

14 Page 14 of 14 Ophthalmologist (45.51, ) (30.83, ) Optometrist (16.70, 29.67) (5.18, 20.63) Total Eye Glasses or Contact Lenses- Related Costs (11.41, 25.98) (-2.31, 15.05) Eye Glasses (11.41, 25.98) (-2.31, 15.05) Contact lenses (0.00, 0.00) (0.00, 0.00) n/a Total Non-Vision Related Medical Treatment-Related Costs (212.93, ) (64.81, ) Hospital emergency room Primary care physician office (14.77, 40.05) (-9.50, 20.62) Specialists (20.82, 36.71) (12.52, 31.45) Admitted into the hospital (2.30, 15.62) (-0.30, 15.57) Total Retinal Specialist Evaluation Costs (154.09, ) (37.14, ) Direct Vision-Related Medical Cost (206.55, ) (248.00, ) Direct Non-Vision Related Medical Cost ( , ) ( , ) Direct Non-Medical Related Cost (223.47, ) (154.19, ) Total Patient Cost (-78.43, ) (513.80, ) Total Fall-Related Costs ( , ) ( , )