Cost-effectiveness of anti-oxidant vitamins plus zinc treatment to prevent the progression of intermediate age-related macular degeneration. A Singapore perspective.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Health Services and Outcomes Research, National Healthcare Group, Singapore.
Nakul
N
Saxena
Pradeep Paul
PP
George
Bee Hoon
BH
Heng
Tock Han
TH
Lim
Shao Onn
SO
Yong
D000328:Adult; D000368:Aged; D000975:Antioxidants / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D014792:Visual Acuity / Q000502:physiology*; D014815:Vitamins / Q000008:administration & dosage* / Q000191:economics; D057135:Wet Macular Degeneration / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D015032:Zinc / Q000008:administration & dosage* / Q000191:economics
D000975:Antioxidants; D014815:Vitamins; D015032:Zinc