Prevalence and Economic Burden of Keratoconus in the United States

Rohan Bir Singh; Uday Pratap Singh Parmar; Vishal Jhanji

doi:10.1016/j.ajo.2023.11.009

Prevalence and Economic Burden of Keratoconus in the United States

Am J Ophthalmol. 2024 Mar:259:71-78. doi: 10.1016/j.ajo.2023.11.009. Epub 2023 Nov 10.

Authors

Rohan Bir Singh¹, Uday Pratap Singh Parmar², Vishal Jhanji³

Affiliations

¹ From the Department of Ophthalmology (R.B.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Population, Policy and Practice Research (R.B.S.), Great Ormond Street Institute of Child Health, University College London, London, UK; Discipline of Ophthalmology and Visual Sciences (R.B.S.), Adelaide Medical School, University of Adelaide, Adelaide, Australia.
² Department of Ophthalmology (U.P.S.P.), Government Medical College and Hospital, Chandigarh, India.
³ Vision Institute (V.J.), Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. Electronic address: jhanjiv@upmc.edu.

PMID: 37951332
DOI: 10.1016/j.ajo.2023.11.009

Abstract

Purpose: To assess the prevalence and economic burden of keratoconus in the United States.

Design: Retrospective cohort study.

Methods: Patients enrolled in Medicaid and Children's Health Insurance Program (CHIP) who were diagnosed with keratoconus between 2016 and 2019 were included. The data reported to the Centers for Disease Control and Prevention (CDC) Vision and Eye Health Surveillance System (VEHSS) were analyzed. The crude prevalence rates (national and statewise) were obtained from the database and extrapolated to estimate the keratoconus case count in the United States. The keratoconus prevalence was compared between male and female individuals using the Mann-Whitney test, whereas Brown-Forsythe 1-way analysis of variance was used to compare prevalence between age and racial groups. The Dunnett T3 multiple comparison test was used for intergroup comparison. Finally, the economic burden of keratoconus was assessed by inflation-adjusted direct costs to patients and total cases in the country.

Results: In the cohort of 69,502,000 patients enrolled for Medicaid and CHIP, the national prevalence of keratoconus was computed to be 0.04% in 2019 and had increased from 0.03% in 2016. The highest prevalence of keratoconus was observed in patients 18 to 39 years of age, followed by patients 40 to 64 years of age; comparable prevalence rates were observed in these age groups in the Black population. The prevalence was moderately higher in female compared to male individuals; however, significantly higher keratoconus prevalence was observed in Black female individuals compared to male individuals. A significantly high prevalence of keratoconus was observed in the Black population, followed by Hispanic population. In 2019, the average inflation-adjusted lifetime cost of keratoconus treatment was USD 28,766.69, with a cumulative economic burden of USD 3.8 billion.

Conclusions: In the United States, keratoconus is most prevalent in individuals 18 to 39 years of age. The keratoconus prevalence is higher in the Black population, specifically female individuals, and the diagnosis is often delayed in these patients.

MeSH terms

Adult
Child
Cost of Illness
Female
Financial Stress
Health Care Costs*
Humans
Keratoconus* / diagnosis
Keratoconus* / epidemiology
Male
Middle Aged
Prevalence
Retrospective Studies
United States / epidemiology