AMD Impact: Cost of Illness Study

On World Sight Day 2022, Retina International launched the data from a global study into the Socio-economic Impact of late-stage Age-related Macular Degeneration (AMD) in Bulgaria, Germany, and USA.

The study provides an insight into the disease burden on patients and caregivers living with these conditions, as well as society at large. Three countries were selected to represent a range of different costs and experiences; the USA has the largest population of individuals impacted by a form of late-stage AMD, while Germany and Bulgaria represent developed and developing economies within the EU, respectively.

What is AMD?

AMD is an eye condition that causes gradual decline of central vision and in advanced stages can impact one’s ability to perform activities of daily living such as reading, driving, and facial recognition. Advanced or late-stage AMD is a leading cause of irreversible blindness and visual impairment in the world and can be classed into two categories: neovascular/wet AMD (nAMD) or dry AMD, often referred to as Geographic Atrophy (GA).

Want to learn more about AMD? Read our blog post.

Economic Impact

The study estimated costs related to direct medical costs, indirect medical costs, productivity, and wellbeing using the mid-value estimate prevalence rates. Topline data from this study estimates that: (Please note that the cost figures presented in the text are considering the mid value prevalence rate of late stage AMD in each country whereas the figures presented in the images are the ranges considering the low and high prevalence rates)


In the USA, the total economic impact of late-stage AMD was estimated at 43.1 bn EUR (49.1bn USD) comprised of:

  • 23.9 bn EUR (27.5 bn USD) being attributed to nAMD, and;
  • 19.2 bn EUR (22.06 bn USD) attributed to GA.

The majority of costs for both conditions could be attributed to productivity i.e., job loss or job reduction due to the condition: 46 % of the total figure for nAMD and 36 % for GA.

In Germany, the total economic impact of late-stage AMD was estimated at 7.6 bn EUR, with:

  • 3.9 bn EUR being attributed to nAMD, and;
  • 3.7 bn EUR attributed to GA.
Charcoal graphic reading The Economic Burden of Late-stage AMD in Germany. Estimated total attributable cost: 7.6 billion EUR (range, 1.4 billion to 28.6 billion EUR). A pie chart shows: wellbeing cost 56%. Productivity cost 25%. Direct cost 11%. Indirect cost 8%. Colourful RI logo in bottom left corner. Retina International AMD Impact Study, Economic Data.


Bulgaria, a developing economy in the European Union, was estimated to have 449.4 m EUR (879.5 m BGN) associated with late-stage AMD out of which:

  • 228.9 m EUR (447.5 m BGN) was associated with nAMD and
  • 220.5 m EUR (431.5 m BGN) was associated with GA.
Charcoal graphic reading the economic burden of late-stage AMD in Bulgaria. Estimated total attributable cost 449.4 million EUR 9 range, 84.60 million to 1.47 billion EUR). A pie graph shows wellbeing cost at 70%, productivity cost is 14%, direct cost is 9%, indirect cost is 7%. At the bottom is the colourful RI logo and label reading Retina International AMD Impact Study: Economic Data.

In both European countries, and across both conditions, wellbeing costs accounted for the largest proportion. Germany reported that 48% of costs associated with nAMD were attributed to wellbeing, while for GA this figure rose to 87%. In Bulgaria, 64% of costs associated with nAMD and 87% of costs associated with GA were attributed to wellbeing.


To learn more about Retina International’s policy actions on conditions of the ageing retina, visit our Retina Action website


Retina International (RI) would like to thank sincerely our members Retina Bulgaria, PRORETINA Deutschland e.V., and Foundation Fighting Blindness (US), in addition to the local clinical liaisons for their collaboration and support on this project. RI would also like to pay acknowledgement to the contribution of Ernst & Young (EY), whom RI engaged to undertake an analysis of these data and compile the report.

The report has been compiled thanks to the financial support of:

  • Alexion, Astra Zeneca Rare Disease Pharmaceuticals
  • Apellis Pharmaceuticals, Inc.
  • Novartis Pharma AG
  • Hoffmann La Roche Ltd


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