{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,25]],"date-time":"2026-01-25T03:28:07Z","timestamp":1769311687938,"version":"3.49.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004337","name":"Roche","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004337","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>In Ecuador, the economic burden of diabetes-related visual impairment has not been studied cohesively. More evidence\u2014that takes into account lost productivity, direct costs, and intangible costs\u2014is required to support public policies that prevent and treat diabetes-related visual impairment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The purpose of this research is to estimate the economic burden of avoidable blindness due to diabetic macular edema in Ecuador.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Costs were estimated in a one-year, retrospective, cost-of-illness study focusing on two groups of people. The first group contains those that have become blind because of a lack of timely medical treatment for diabetic retinopathy (DR) and diabetic macular edema (DME). The second group contains those that could avoid blindness by receiving timely treatment. Productivity costs are costs associated with lost ability to work due to death, and with impaired (or lost) ability to work or to engage in leisure activities due to morbidity. Direct costs include direct healthcare costs and direct non-healthcare costs, i.e., costs incurred by patients and caregivers in the complete treatment of the disease. Intangible costs are a conceptual cost-compound which takes into account psychological aspects of disease such as anxiety\/distress, and stigmatization.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the year 2023, treating blindness caused by diabetic retinopathy and diabetic macular edema represents a yearly expense of USD 259.7 million\u201492.4% can be attributed to productivity costs. Preventing blindness caused by diabetic retinopathy and diabetic macular edema represents a yearly expense of USD 108.5 million\u201473.8% corresponds to costs of resources used in interventions for health promotion and disease prevention, only 26.2% corresponds to medical treatment. The difference between these two scenarios is 151.2 million; in other words, the cost of treating a person that has become disabled costs USD 33,518.98 more per year than trying to prevent the disability.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The cost to society of providing timely treatment for diabetic retinopathy and diabetic macular edema is significantly less than the cost of supporting a person that has become blind due to lack of treatment. Thus, it would be prudent to invest in public policies that prevent and treat diabetes-related visual impairment.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1476932","type":"journal-article","created":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:25:51Z","timestamp":1752470751000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Economic burden of avoidable blindness due to diabetic macular edema in Ecuador"],"prefix":"10.3389","volume":"13","author":[{"given":"Ruth","family":"Lucio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Antonio","family":"Teran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paula","family":"Luque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"B1","volume-title":"World Report on Vision","author":"Cieza","year":"2019"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e489","DOI":"10.1016\/S2214-109X(21)00138-8","article-title":"The lancet global health commission on global eye health: vision beyond 2020","volume":"9","author":"Burton","year":"2021","journal-title":"Lancet Global Health"},{"key":"B3","volume-title":"Diagn\u00f3stico situacional de la salud ocular por curso de vida en los pa\u00edses andinos: Bolivia, Chile, Colombia, Ecuador, Per y Venezuela","year":"2022"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e130","DOI":"10.1016\/S2214-109X(20)30425-3","article-title":"Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study","volume":"9","author":"Bourne","year":"2021","journal-title":"Lancet Global Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e144","DOI":"10.1016\/S2214-109X(20)30489-7","article-title":"Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study","volume":"9","author":"Steinmetz","year":"2021","journal-title":"Lancet Global Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e106","DOI":"10.1016\/S2214-109X(13)70145-1","article-title":"Global prevalence of age-related macular degeneration and disease burden projection for 2020 and 2040: a systematic review and meta-analysis","volume":"2","author":"Wong","year":"2014","journal-title":"Lancet Global Health"},{"key":"B7","unstructured":"Diabetes WHO Fact Sheets\n          \n          2023"},{"key":"B8","doi-asserted-by":"publisher","first-page":"556","DOI":"10.2337\/dc11-1909","article-title":"Global prevalence and major risk factors of diabetic retinopathy","volume":"35","author":"Yau","year":"2012","journal-title":"Diab Care"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1244","DOI":"10.1016\/j.survophthal.2022.01.009","article-title":"Prevalence of diabetic macular edema based on optical coherence tomography in people with diabetes: a systematic review and meta-analysis","volume":"67","author":"James","year":"2022","journal-title":"Surv Ophthalmol"},{"key":"B10","unstructured":"Diabetic Retinopathy in Latin America. Global Ophthalmology Guide\n          \n          2016"},{"key":"B11","unstructured":"34926106\n          Estad\u00edsticas de Discapacidad.\n          \n          2023"},{"key":"B12","doi-asserted-by":"publisher","first-page":"e022188","DOI":"10.1136\/bmjopen-2018-022188","article-title":"Global prevalence of diabetic retinopathy: protocol for a systematic review and meta-analysis","volume":"9","author":"Cheloni","year":"2019","journal-title":"BMJ Open"},{"key":"B13","author":"Barr\u00eda","year":"2011","journal-title":"2010 Gu\u00eda pr\u00e1ctica cl\u00ednica de retinopat\u00eda diabtica para latinoamrica"},{"key":"B14","author":"Barr\u00eda","year":"2016","journal-title":"2016 Actualizaci\u00f3n de la gu\u00eda cl\u00ednica de retinopat\u00eda diabtica"},{"key":"B15","unstructured":"Estad\u00edsticas Vitales: Registro Estad\u00edstico de Defunciones Generales.\n          \n          2023"},{"key":"B16","unstructured":"Segel\n              J\n            \n          \n          Cost-of-Illness Studies: A Primer\n          \n          2006"},{"key":"B17","unstructured":"Puig-Junoy\n              J\n            \n            \n              Pinto-Prades\n              JL\n            \n          \n          El coste de oportunidad del tiempo remunerado en la producci\u00f3n de salud\n          \n          2001"},{"key":"B18","unstructured":"Development of a matrix of cost domains in economic evaluation of rheumatoid arthritis\n          \n          657\n          61\n          \n            \n              Merkesdal\n              S\n            \n            \n              Ruof\n              J\n            \n            \n              Huelsemann\n              JL\n            \n            \n              Schoeffski\n              O\n            \n            \n              Maetzel\n              A\n            \n            \n              Mau\n              W\n            \n          \n          J Rheumatol\n          28\n          2001"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e001287","DOI":"10.1136\/rmdopen-2020-001287","article-title":"Cost assessment of health interventions and diseases","volume":"6","author":"Fautrel","year":"2020","journal-title":"RMD Open"},{"key":"B20","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1093\/oso\/9780195108248.003.0006","article-title":"Estimating costs in cost-effectiveness analysis","author":"Luce","year":"1996","journal-title":"Cost-Effectiveness in Health and Medicine"},{"key":"B21","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780198529446.001.0001","volume-title":"Methods for the Economic Evaluation of Health Care Programmes (third edition)","author":"Drummond","year":"2005"},{"key":"B22","unstructured":"Reporte de pobreza, ingreso y desigualdad: resultados a junio de 2022.\n          \n          2022"},{"key":"B23","unstructured":"INEC Encuesta Nacional de Empleo, Desempleo y Subempleo anual (ENEMDU) Febrero 2023.\n          \n          2023"},{"key":"B24","year":"2020","journal-title":"Global Burden of Disease Study 2019 (GBD 2019) Disability Weights"},{"key":"B25","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/S0002-9394(02)02110-4","article-title":"The magnitude and cost of global blindness: an increasing problem that can be alleviated","volume":"135","author":"Frick","year":"2003","journal-title":"Am J Ophthalmol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1007\/s00431-003-1341-5","article-title":"Health economic issues of screening programmes","volume":"162","author":"Wildner","year":"2003","journal-title":"Eur J Pediatr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"634","DOI":"10.1001\/jamaophthalmol.2019.0446","article-title":"Association of vision loss with hospital use and costs among older adults","volume":"137","author":"Morse","year":"2019","journal-title":"JAMA Ophthalmol"},{"key":"B28","year":"2014","journal-title":"Tarifario de prestaciones para el sistema nacional de salud."},{"key":"B29","unstructured":"Camas y Egresos Hospitalarios\n          \n          2023"},{"key":"B30","unstructured":"Cuentas Satlite de Salud 2007-2021\n          \n          2022"},{"key":"B31","year":"2023","journal-title":"Presupuesto General del Estado 2023"},{"key":"B32","unstructured":"Estrategia de abordaje Mdico del Barrio\n          \n          2019"},{"key":"B33","unstructured":"Ley Org\u00e1nica de Discapacidades\n          \n          2012"},{"key":"B34","unstructured":"Agenda Nacional para la Igualdad de Discapacidades 2017-2021\n          \n          2017"},{"key":"B35","unstructured":"Registro Estad\u00edstico de Recursos y Actividades de Salud.\n          \n          2020"},{"key":"B36","volume-title":"Panorama de la protecci\u00f3n social","year":"2021"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1476932\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T05:25:56Z","timestamp":1752470756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1476932\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":36,"alternative-id":["10.3389\/fpubh.2025.1476932"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1476932","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,14]]},"article-number":"1476932"}}