The Cost of Lost Productivity from Amblyopia
A “Median” Child with Amblyopia
To put the costs in perspective, consider a “median” child with amblyopia. The life expectancy of this child is 77.7 years (according to the U.S. Census Bureau), and his likely working span is 47 years. A child without disabilities could expect to earn the median income level over these work years. That is presently $25,000 annually, but this will grow in dollar terms over his lifetime with inflation and growth in productivity. Conversely, these future income streams need to be discounted back by an appropriate discount rate to put income flows in current dollars. We have used as a discount rate the rate of growth of median income to discount future income streams. In present value terms, then, each future year’s income in today’s dollars will be $25,000. For the 47 working years of his life, he will earn a total of $1,175,000 in today’s dollars. If he has amblyopia, on average his earnings will be cut by 12 percent, or by $141,000. This will happen for each child suffering from amblyopia. Multiplying the per lifetime decrement in earnings ($141,000) by the annual estimated incidence of amblyopia (124,000) gives a total of $17.5 billion of lifetime income loss for each year’s cohort of children who develop amblyopia. If these children are screened and treated at a 50 percent expected effectiveness rate, the lifetime costs of amblyopia for a year’s cohort will drop by $8.75 billion. This results in a net economic benefit of $7.5 billion and a ratio of benefits to the costs of the screening and treatment of seven-to-one.
Improved Screening and Treatment
This favorable outcome assumes that technology and procedures remain as they are now. But it may be possible to increase detection effectiveness by more elaborate screening techniques, such as newer and automated technologies such as computer-assisted photorefraction. Suppose that additional screening enables clinicians to raise the detection and successful treatment rate from 50 percent to 90 percent, but at, for example, triple the cost of present detection techniques and procedures. That tripled cost would be $3.72 billion But the gains—the reduction in economic costs of the illness–would climb to 90 percent of $17.5 billion, or $15.75 billion. That would result in a net economic benefit of $12 billion and a positive benefit-to-cost ratio in excess of four-to-one, attractive from a public policy standpoint.
Assuming approximately 10 percent of U.S. births occur in Texas, the state’s share of this net economic benefit of “renewable” and sustainable economic growth would be $1.6 billion for an investment of $372 million, to say nothing of the fundamental human good of seeing an end to preventable vision loss in children.
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