Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data. Issue 4 (23rd August 2017)

• Record Type: Journal Article
• Authors: Lee, Aaron Y; Butt, Thomas; Chew, Emily; Agron, Elvira; Clemons, Traci E; Egan, Catherine A; Lee, Cecilia S; Tufail, Adnan
• Is Part Of: British journal of ophthalmology. Volume 102:Issue 4(2018)
• Page Start: 465
• Page End: 472
• Publication Date: 2017-08-23
• Subjects: age-related macular degeneration -- supplements -- cost-effectiveness -- health economics; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2017-310939
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aims: To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4. Methods: A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. Setting: UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. Interventions: Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. Main outcome measures: quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. Results: For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient. Conclusions: The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy.