The Clinical Effectiveness and Cost-Effectiveness of Screening for Age-Related Macular Degeneration in Japan: A Markov Modeling Study

Abstract

ObjectiveTo investigate the cost-effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan.MethodsThe 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.ResultsIn 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.ConclusionsOphthalmologic 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.

Anti‐vascular endothelial growth factors treatment of wet age‐related macular degeneration: from neurophysiology to cost‐effectiveness

“…In Japan, the screening of wet AMD has been shown to be effective in reducing blindness, but it is not cost‐effective (Tamura et al. ). When the analysis of genes and inheritance mapping becomes routine, perhaps it will be possible to identify the high‐risk individuals and monitor them more closely in order to start the medication immediately when the signs of wet AMD are detected.…”

To Screen or Not to Screen

“…64 For example, a Markov model could be used to simulate the impact of a hypothetical program screening for pediatric abusive head trauma despite an extremely scarce literature on the performance of possible tests and the definition and length of the preclinical phase. 65 Similar models have been developed, for example, for screening for psychosis, 66 agerelated macular degeneration, 67 and prostate cancer. 68 Models are also potentially appropriate to consider the potential effects of issues such as selection, detection, lead time, overdiagnosis, sticky diagnosis, and slippery linkage.…”

Telemedicine for Age-Related Macular Degeneration

“…2 Some groups have found value by adding screening for AMD to existing DR screening programs, 3,4 but others have not found screening programs for AMD to be cost-effective. 5 Several groups have investigated the feasibility and validity of telehealth programs for AMD. Owing to the uncertainty of the role of screening for AMD, several groups have explored other telehealth paradigms for this disease.…”