Model study of AREDS antioxidant supplementation of AMD compared to Visudyne: A dominant strategy?

Abstract

objectives 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 AMD would decrease the costs of photodynamic treatment with Visudyne. perspective Third party payer, the Ontario Health Insurance Plan. methods Using reported risk reductions, prevalence data by age and sex from the Beaver Dam studies, and yearly costs: AREDS C$182.50, potential savings were calculated as the difference or incremental cost between the estimated medical costs for the untreated cohort of $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. Different scenarios were explored for sensitivity analysis of direct cost savings. results For the Ontario cohort of approximately 788,000 aged 51-55 years in 2001, for photodynamic therapy of the untreated cohort, modeled costs were $1.7 billion. AREDS treatment costs would be $513 million. AREDS would reduce photodynamic therapy costs, a net saving of $431 million, a saving of $547 per person in the total cohort, or $6,753 per stage 3 and 4 patient treated. To explore the sensitivity of this model to AMD incidence rather than prevalence data, Framingham incidence data were incorporated in the model: net savings of $70.3 million were modeled using Framingham incidence data. conclusion Under reasonable assumptions, if the case progresses to wet AMD (1) AREDS with Visudyne is less expensive than Visudyne alone in every five-year time period for the cohort that is age 50-54 right now until they become 75-79; thus, the lifetime cost is lower; (2) AREDS with Visudyne yields more QALYs than Visudyne alone in every five-year interval; (3) under all but the most extreme assumptions, the conclusions reached are robust. Even when AREDS costs a little more, it yields more QALYs at a reasonable cost per QALY. Thus, AREDS antioxidant supplementation appears to be a dominant strategy for macular degeneration. Applied to the whole Canadian population, the potential medical cost savings for Visudyne treatment of neovascular AMD are $5.6 billion dollars in direct costs. These values would be tenfold higher for the USA, because of the currency and population size differences.

• Age-related macular degeneration
• risk reduction
• cost savings
• economic effects
• antioxidant therapy
• vitamin E
• oxidative stress
• photodynamic therapy
• Visudyne