title: The Clinical Effectiveness and Cost-Effectiveness of Screening for Age-Related Macular Degeneration in Japan: A Markov Modeling Study.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan.
  
  
  METHODS
  The clinical effectiveness and cost-effectiveness of screening and subsequent intervention for AMD were assessed using a Markov model. The Markov model simulation began at the age of 40 years and concluded at the age of 90 years. The first-eye and second-eye combined model assumed an annual state-transition probability, development of prodromal symptoms, choroidal neovascularization (CNV), and reduction in visual acuity. Anti-vascular-endothelial-growth-factor (anti-VEGF) intravitreal injection therapy and photodynamic therapy (PDT) were performed to treat CNV. Intake of supplements was recommended to patients who had prodromal symptoms and unilateral AMD. Data on prevalence, morbidity, transition probability, utility value of each AMD patient, and treatment costs were obtained from published clinical reports.
  
  
  RESULTS
  In the base-case analysis, screening for AMD every 5 years, beginning at the age of 50 years, showed a decrease of 41% in the total number of blind patients. The screening program reduced the incidence of blindness more than did the additional intake of supplements. However, the incremental cost-effectiveness ratio (ICER) of screening versus no screening was 27,486,352 Japanese yen (JPY), or 259,942 US dollars (USD) per quality-adjusted life year (QALY). In the sensitivity analysis, prodromal symptom-related factors for AMD had great impacts on the cost-effectiveness of screening. The lowest ICER obtained from the best scenario was 4,913,717 JPY (46,470 USD) per QALY, which was approximately equal to the willingness to pay in Japan.
  
  
  CONCLUSIONS
  Ophthalmologic screening for AMD in adults is highly effective in reducing the number of patients with blindness but not cost-effective as demonstrated by a Markov model based on clinical data from Japan.
authors.affiliation: Division of Medical Information Technology & Administration Planning, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan; Department of Ophthalmology & Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tamura
authors.affiliation: Hakubi Center of Advanced Research, Kyoto University, Yoshida, Sakyo, Kyoto 606-8501, Japan; Graduate School of Economics, Kyoto University, Yoshida, Sakyo, Kyoto 606-8501, Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Goto
authors.affiliation: National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Akune
authors.affiliation: Department of Health and Welfare Services, National Institute of Public Health, Wako, Japan.
authors.forename: Yoshimune
authors.initials: Y
authors.lastname: Hiratsuka
authors.affiliation: Division of Medical Information Technology & Administration Planning, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
authors.forename: Shusuke
authors.initials: S
authors.lastname: Hiragi
authors.affiliation: Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008268:Macular Degeneration / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008390:Markov Chains; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D009017:Morbidity; D015203:Reproducibility of Results; D016896:Treatment Outcome