Abstract
Abstract: :
Purpose: In Ontario, Canada, in a cohort of all people initially aged 50–54 years, modeling whether the Age–Related Eye Disease Study (AREDS) antioxidant supplementation for stage 3 and 4 Age–Related Macular Degeneration (AMD) would decrease costs of photodynamic treatment by Visudyne? Perspective: Third party payer, the Ontario Health Insurance Plan. Methods:Using reported risk reductions, incidence and prevalence data by age and sex from the Framingham, and Beaver Dam studies, respectively, and yearly costs: AREDS C$182.5O, potential savings were calculated as the difference and incremental cost between the estimated medical costs for the untreated cohort of C$17,000 for Visudyne treatment of individuals with neovascularization, and the same cohort if stage 3 and 4 AMD patients were treated with antioxidants, decreasing progression to neovascularization. Results:For the Ontario cohort of ca. 788,000 aged 51–55 years in 2001, for photodynamic therapy of the untreated cohort, modeled costs were C$1.7 billion for Beaver Dam prevalence C$224 million for Framingham incidence data. AREDS treatment costs would be C$513 million for Beaver Dam or C$ 85 million for Framingham. AREDS would reduce photodynamic therapy costs, a net saving C$431 million using Beaver Dam prevalence data, a savings of C$547 per person in the total cohort, or C$ 6,753 per stage 3 and 4 patient treated. Alternatively, net savings of C$70.3 million were modeled using Framingham incidence data. Quality adjusted life years (QALYs) would also be saved by AREDS antioxidant supplements: 51,979 for Framingham, or 246,592 for Beaver Dam models. Worst case modeling also showed savings for Framingham incidence(C$ 9.6 million) but a net cost of C$ 265 million for the Beaver Dam model. Conclusions:AREDS antioxidant supplementation appears to be a dominant strategy for treating macular degeneration. Applied to the whole Canadian population, the potential medical cost savings for Visudyne treatment of neovascular AMD are C$5.6 billion dollars direct costs. These values would be tenfold higher for the USA, because of the currency and population size differences.
Keywords: antioxidants • retina • age–related macular degeneration