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 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 pound 406; fundus assessment, 19 pound 649; Amsler grid, 19 pound 751; patient's subjective assessment, 20 pound 198 and visual acuity, 20 pound 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 pound 000-30 pound 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.

Automated summary

The study evaluated the cost-effectiveness of non-invasive monitoring tests for detecting neovascular age-related macular degeneration and found that spectral domain optical coherence tomography (SD-OCT) was the most effective method, generating higher quality-adjusted life-years and lower health and social care costs per patient compared to other individual tests. The early treatment of the second eye following confirmation of SD-OCT positive findings is expected to maintain better visual acuity and quality of life while reducing overall healthcare costs over patients' lifetimes.