Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study

Rodolfo Hernandez, Charlotte Kennedy, Katie Banister, Beatriz Goulao, Jonathan Cook, Sobha Sivaprasad, Ruth Hogg, Augusto Azuara-Blanco, Heinrich Heimann, Maria Dimitrova, Richard Gale, Mia Porteous, Craig R Ramsay, Usha Chakravarthy, Graham S Scotland*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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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 National Health Service (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 (SD-OCT). Diagnosis of nAMD was confirmed by fundus fluorescein angiography (FFA) before prompt initiation of antivascular 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 with 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 may reduce costs of health and social care over the lifetime of patients.

Original languageEnglish
Pages (from-to)1754-1761
Number of pages8
JournalBritish Journal of Ophthalmology
Volume106
Issue number12
Early online date02 Aug 2021
DOIs
Publication statusPublished - Dec 2022

Keywords

  • neovascularisation
  • diagnostic tests/investigation
  • macula

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