Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study
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 se...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2021
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| _version_ | 1826309436061253632 |
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| author | Hernandez, R Kennedy, C Banister, K Goulao, B Cook, J Sivaprasad, S Hogg, R Azuara-Blanco, A Heimann, H Drimitrova, M Gale, R Porteous, M Ramsay, C Chakravarthy, U Scotland, G |
| author_facet | Hernandez, R Kennedy, C Banister, K Goulao, B Cook, J Sivaprasad, S Hogg, R Azuara-Blanco, A Heimann, H Drimitrova, M Gale, R Porteous, M Ramsay, C Chakravarthy, U Scotland, G |
| author_sort | Hernandez, R |
| collection | OXFORD |
| description | 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.
Data availability statement
Data are available on reasonable request. Requests for data from the EDNA study can be made via the corresponding author.
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| first_indexed | 2024-03-07T07:34:08Z |
| format | Journal article |
| id | oxford-uuid:e704da5b-5971-4199-9fbb-42174e126842 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:34:08Z |
| publishDate | 2021 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:e704da5b-5971-4199-9fbb-42174e1268422023-02-16T13:02:11ZEarly detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA studyJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e704da5b-5971-4199-9fbb-42174e126842EnglishSymplectic ElementsBMJ Publishing Group2021Hernandez, RKennedy, CBanister, KGoulao, BCook, JSivaprasad, SHogg, RAzuara-Blanco, AHeimann, HDrimitrova, MGale, RPorteous, MRamsay, CChakravarthy, UScotland, GBackground/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. Data availability statement Data are available on reasonable request. Requests for data from the EDNA study can be made via the corresponding author. |
| spellingShingle | Hernandez, R Kennedy, C Banister, K Goulao, B Cook, J Sivaprasad, S Hogg, R Azuara-Blanco, A Heimann, H Drimitrova, M Gale, R Porteous, M Ramsay, C Chakravarthy, U Scotland, G Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title | Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title_full | Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title_fullStr | Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title_full_unstemmed | Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title_short | Early detection of neovascular age-related macular degeneration: an economic evaluation based on data from the EDNA study |
| title_sort | early detection of neovascular age related macular degeneration an economic evaluation based on data from the edna study |
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