Cost‑effectiveness of anti‑oxidant vitamins plus zinc treatment to prevent the progression of intermediate age‑related macular degeneration. A Singapore perspective.
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Date
2015-06
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Abstract
Purpose: To determine if providing high dose anti‑oxidant vitamins and zinc treatment age‑related eye disease
study (AREDS formulation) to patients with intermediate age‑related macular degeneration (AMD) aged 40–79 years
from Singapore is cost‑effective in preventing progression to wet AMD. Methods: A hypothetical cohort of category
3 and 4 AMD patients from Singapore was followed for 5 calendar years to determine the number of patients who
would progress to wet AMD given the following treatment scenarios: (a) AREDS formulation or placebo followed
by ranibizumab (as needed) for wet AMD. (b) AREDS formulation or placebo followed by bevacizumab (monthly)
for wet AMD. (c) AREDS formulation or placebo followed by aflibercept (VIEW I and II trial treatment regimen).
Costs were estimated for the above scenarios from the providers’ perspective, and cost‑effectiveness was measured
by cost per disability‑adjusted life year (DALY) averted with a disability weight of 0.22 for wet AMD. The costs
were discounted at an annual rate of 3%. Results: Over 5400 patients could be prevented from progressing to wet
AMD cumulatively if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab was
cost‑effective compared to placebo‑ranibizumab or placebo‑aflibercept combinations (cost per DALY averted:
SGD$23,662.3 and SGD$21,138.8, respectively). However, bevacizumab (monthly injections) alone was more
cost‑effective compared to AREDS formulation followed by bevacizumab. Conclusion: Prophylactic treatment with
AREDS formulation for intermediate AMD patients followed by ranibizumab or for patients who progressed to wet
AMD was found to be cost‑effective. These findings have implications for intermediate AMD screening, treatment
and healthcare planning in Singapore.
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Keywords
Age‑related macular degeneration, anti‑oxidant vitamins, cost‑effectiveness analysis, Singapore
Citation
Saxena Nakul, George Pradeep Paul, Heng Bee Hoon, Lim Tock Han, Yong Shao Onn. Cost‑effectiveness of anti‑oxidant vitamins plus zinc treatment to prevent the progression of intermediate age‑related macular degeneration. A Singapore perspective. Indian Journal of Ophthalmology. 2015 June; 63(6): 516-523.