title: Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System.
abstract: Medicare recently approved coverage of home telemonitoring for early detection of incident choroidal neovascularization (CNV) among patients with age-related macular degeneration (AMD), but no economic evaluation has yet assessed its cost-effectiveness and budgetary impact.
  
  
  
  To evaluate a home-based daily visual-field monitoring system using simulation methods and to apply the findings of the Home Monitoring of the Eye study to the US population at high risk for wet-form AMD.
  
  
  
  In this economic analysis, an evaluation of the potential cost, cost-effectiveness, and government budgetary impact of adoption of a home-based daily visual-field monitoring system among eligible Medicare patients was performed. Effectiveness and visual outcomes data from the Age-Related Eye Disease Study 2 Home Monitoring of the Eye study, treatment data from the Wills Eye Hospital Treat & Extend study, and AMD progression data from the Age-Related Eye Disease Study 1 were used to simulate the long-term effects of telemonitoring patients with CNV in one eye or large drusen and/or pigment abnormalities in both eyes. Univariate and probabilistic sensitivity analysis and an alternative scenario using the Treat & Extend study control group outcomes were used to examine uncertainty in these data and assumptions.
  
  
  
  Home telemonitoring of patients with AMD for early detection of CNV vs usual care.
  
  
  
  Incremental cost-effectiveness ratio, net present value of lifetime societal costs, and 10-year nominal government expenditures.
  
  
  
  Telemonitoring of patients with existing unilateral CNV or multiple bilateral risk factors for CNV (large drusen and retinal pigment abnormalities) incurs $907 (95% CI, -$6302 to $2809) in net lifetime societal costs, costs $1312 (95% CI, $222-$2848) per patient during 10 years from the federal government's perspective, and results in an incremental cost-effectiveness ratio of $35 663 (95% CI, cost savings to $235 613) per quality-adjusted life-year gained.
  
  
  
  Home telemonitoring of patients with AMD who are at risk for CNV was cost-effective compared with scheduled examinations alone. Monitoring patients with existing CNV in one eye is cost saving, but monitoring is generally not cost-effective among patients with low risk of CNV, including those with no or few risk factors. With Medicare coverage, monitoring incurs budgetary expenditures for the government but is cost-saving for patients at high risk of AMD. Monitoring could be cost saving to society if monitoring reduced the frequency of scheduled examinations or led to a reduction of one or more injections of ranibizumab.
authors.affiliation: NORC at the University of Chicago, Chicago, Illinois.
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.affiliation: The Emmes Corporation, Rockville, Maryland.
authors.forename: Traci
authors.initials: T
authors.lastname: Clemons
authors.affiliation: Wills Eye Hospital, Bryn Mawr, Pennsylvania.
authors.forename: Carl
authors.initials: C
authors.lastname: Regillo
authors.affiliation: Wills Eye Hospital, Bryn Mawr, Pennsylvania.
authors.forename: Nadim
authors.initials: N
authors.lastname: Rayess
authors.affiliation: The Chartis Group, Chicago, Illinois.
authors.forename: Danielle
authors.initials: D
authors.lastname: Liffmann Kruger
authors.affiliation: NORC at the University of Chicago, Chicago, Illinois.
authors.forename: David
authors.initials: D
authors.lastname: Rein
mesh_terms: D000368:Aged; D020256:Choroidal Neovascularization / Q000175:diagnosis* / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000191:economics* / Q000295:instrumentation; D015203:Reproducibility of Results; D017216:Telemedicine / Q000191:economics* / Q000295:instrumentation; D014481:United States; D014792:Visual Acuity; D014794:Visual Fields; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000503:physiopathology