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 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 (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
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 reduce costs of health and social care over the lifetime of patients.
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
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 reduce costs of health and social care over the lifetime of patients.
| Original language | English |
|---|---|
| Pages (from-to) | 1754-1761 |
| Number of pages | 8 |
| Journal | British Journal of Ophthalmology |
| Volume | 106 |
| Issue number | 12 |
| Early online date | 2 Aug 2021 |
| DOIs | |
| Publication status | Published - 22 Nov 2022 |
Bibliographical note
Funding: The project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme (grant number: 12/142/07) and will be published in full in Health Technology Assessment. The funder was not involved in the study design; in the collection, analysis and interpretation of the data; in the writing of the report; and in the decision to submit the paper for publication. The Health Services Research Unit (HSRU) and the Health Economics Research Unit (HERU) are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate (HSRU/2021-2024, HERU/2021-2024).Keywords
- age-related macular degeneration
- cost-effectiveness
- health economics