Cost Effectiveness of Anti-Oxidant Vitamin + Zinc Treatment to Prevent the Progression of Intermediate Dry AMD to its Wet Form. A Singapore Perspective.

Abstract

 

Purpose

 

To determine if providing high dose anti-oxidant vitamins + Zinc treatment (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 & 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. Crude annual mortality rate was incorporated into the model. **Is this still applicable now that YLLs are no longer part of the analysis?**

 

Results

 

Over 5,400 patients could be prevented from progressing to Wet AMD cumulatively over five years if AREDS formulation were prescribed. AREDS formulation followed by ranibizumab or aflibercept was cost effective compared to either placebo-ranibizumab or placebo-aflibercept combinations (cost per DALY averted: SGD$17,078.7 and SGD$14,299.8 respectively - well within the cost-effectiveness threshold). However, bevacizumab (monthly injections) alone was more cost effective compared to preventive anti-oxidant vitamins + Zn followed by bevacizumab. Cost savings as a result of prescribing AREDS formulation were SGD$46.7M and SGD$39.1M for ranibizumab and aflibercept arms respectively over 5 years.

 

Conclusions

 

Prophylactic treatment with high dose anti-oxidant vitamins + Zn for intermediate AMD patients, followed by ranibizumab or aflibercept 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.

 

 

DALYs associated with Wet AMD based on receipt or no receipt of AREDS formulation over 5 years.

 

 

Cost per DALY averted based on possible treatment options for patients with Wet AMD

 

Keywords: 412 age-related macular degeneration • 460 clinical (human) or epidemiologic studies: health care delivery/economics/manpower • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials