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

2018 04

Journal Article

Lee, A.Y.; Butt, T.; Chew, E.; Agrón, E.; Clemons, T.E.; Egan, C.A.; Lee, C.S.; Tufail, A.

Br J Ophthalmol






Antioxidants; Cost-Benefit Analysis; Dietary Supplements; Humans; Macular Degeneration; Markov Chains; Middle Aged; Models, Economic; United Kingdom; visual acuity; Zinc

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.

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