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 (SDOCT). Diagnosis of nAMD was confirmed by fundus fluorescein angiography (FFA) before prompt initiation of anti-vascular 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 to 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
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 reduce costs of health and social care over the lifetime of patients.
- age-related macular degeneration
- health economics