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Br J Ophthalmol. 2018 Apr;102(4):465-472. doi: 10.1136/bjophthalmol-2017-310939. Epub 2017 Aug 23.

Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data.

Author information

1
Department of Ophthalmology, University of Washington, Seattle, Washington, USA.
2
Institute of Ophthalmology, University College London, London, UK.
3
Division of Epidemiology and Clinical Research, National Institutes of Health, Bethesda, Maryland, USA.
4
Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA.
5
EMMES Corporation, Rockville, Maryland, USA.
6
Moorfields Eye Hospital, London, UK.

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.

KEYWORDS:

age-related macular degeneration; cost-effectiveness; health economics; supplements

PMID:
28835423
PMCID:
PMC5825252
DOI:
10.1136/bjophthalmol-2017-310939
[Indexed for MEDLINE]
Free PMC Article

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