Abstract
ObjectiveTo investigate the cost-effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan.MethodsThe clinical effectiveness and cost-effectiveness of screening and subsequent intervention for AMD were assessed using a Markov model. The Markov model simulation began at the age of 40 years and concluded at the age of 90 years. The first-eye and second-eye combined model assumed an annual state-transition probability, development of prodromal symptoms, choroidal neovascularization (CNV), and reduction in visual acuity. Anti–vascular-endothelial-growth-factor (anti-VEGF) intravitreal injection therapy and photodynamic therapy (PDT) were performed to treat CNV. Intake of supplements was recommended to patients who had prodromal symptoms and unilateral AMD. Data on prevalence, morbidity, transition probability, utility value of each AMD patient, and treatment costs were obtained from published clinical reports.ResultsIn the base-case analysis, screening for AMD every 5 years, beginning at the age of 50 years, showed a decrease of 41% in the total number of blind patients. The screening program reduced the incidence of blindness more than did the additional intake of supplements. However, the incremental cost-effectiveness ratio (ICER) of screening versus no screening was 27,486,352 Japanese yen (JPY), or 259,942 US dollars (USD) per quality-adjusted life year (QALY). In the sensitivity analysis, prodromal symptom-related factors for AMD had great impacts on the cost-effectiveness of screening. The lowest ICER obtained from the best scenario was 4,913,717 JPY (46,470 USD) per QALY, which was approximately equal to the willingness to pay in Japan.ConclusionsOphthalmologic screening for AMD in adults is highly effective in reducing the number of patients with blindness but not cost-effective as demonstrated by a Markov model based on clinical data from Japan.
Highlights
Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries.[1,2,3,4,5,6] In Japan, AMD ranks fourth among the causes of visual impairment, and about 700,000 patients suffer from the disease.[7, 8] no treatment for AMD has been available until recently, AMD is commonly treated with anti–vascular-endothelial-growth-factor intravitreal injection therapy and photodynamic therapy (PDT).[9]
Ophthalmologic screening for AMD in adults is highly effective in reducing the number of patients with blindness but not cost-effective as demonstrated by a Markov model based on clinical data from Japan
No treatment for AMD has been available until recently, AMD is commonly treated with anti–vascular-endothelial-growth-factor intravitreal injection therapy and photodynamic therapy (PDT).[9]
Summary
Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries.[1,2,3,4,5,6] In Japan, AMD ranks fourth among the causes of visual impairment, and about 700,000 patients suffer from the disease.[7, 8] no treatment for AMD has been available until recently, AMD is commonly treated with anti–vascular-endothelial-growth-factor (anti-VEGF) intravitreal injection therapy and photodynamic therapy (PDT).[9] AMD frequently develops in only one eye of an elderly person; binocular involvement of AMD is minor[10, 11] because of slow involvement of the other eye.[12,13,14] Patients may be unaware of their vision changes in daily life when only one of the two eyes is affected, because the impairment of quality of life (QOL) may be limited. It may be difficult to detect early-stage AMD, monocular AMD, and subsequent adequate treatment of AMD may be delayed. Treatment for AMD has economic costs to the patients and to society, and the injections require frequent visits to medical institutions over a long period. Conclusions on the reported cost-effectiveness of therapies for AMD are not consistent.[15,16,17]
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