Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study. Issue 12 (2nd August 2021)

• Record Type: Journal Article
• Authors: Hernandez, Rodolfo; Kennedy, Charlotte; Banister, Katie; Goulao, Beatriz; Cook, Jonathan; Sivaprasad, Sobha; Hogg, Ruth; Azuara-Blanco, Augusto; Heimann, Heinrich; Dimitrova, Maria; Gale, Richard; Porteous, Mia; Ramsay, Craig R; Chakravarthy, Usha; Scotland, Graham S
• Is Part Of: British journal of ophthalmology. Volume 106:Issue 12(2022)
• Page Start: 1754
• Page End: 1761
• Publication Date: 2021-08-02
• Subjects: neovascularisation -- macula -- diagnostic tests/investigation; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2021-319506
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Background/aims: To evaluate the cost-effectiveness of non-invasive monitoring tests to detect the onset of neovascular age-related macular degeneration (nAMD) in the unaffected second eye of patients receiving treatment for unilateral nAMD in a UK National Health Service (NHS) hospital outpatient setting. Methods: A patient-level state transition model was constructed to simulate the onset, detection, and treatment of nAMD in the second eye. Five index tests were compared: self-reported change in visual function, Amsler test, clinic measured change in visual acuity from baseline, fundus assessment by clinical examination or colour photography, and spectral domain optical coherence tomography (SD-OCT). Diagnosis of nAMD was confirmed by fundus fluorescein angiography (FFA) before prompt initiation of antivascular endothelial growth factor treatment. Quality-adjusted life-years (QALYs) and costs of health and social care were modelled over a 25-year time horizon. Results: SD-OCT generated more QALYs (SD-OCT, 5.830; fundus assessment, 5.787; Amsler grid, 5.736, patient's subjective assessment, 5.630; and visual acuity, 5.600) and lower health and social care costs (SD-OCT, £19 406; fundus assessment, £19 649; Amsler grid, £19 751; patient's subjective assessment, £20 198 and visual acuity, £20 444) per patient compared with other individual monitoring tests. Probabilistic sensitivity analysis indicated a high probability (97%–99%) of SD-OCT being the preferred test across a range of cost-effectiveness thresholds (£13 000–£30 000) applied in the UK NHS. Conclusions: Early treatment of the second eye following FFA confirmation of SD-OCT positive findings is expected to maintain better visual acuity and health-related quality of life and may reduce costs of health and social care over the lifetime of patients.