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

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  • Hiroshi Tamura
  • Rei Goto
  • Yoko Akune
  • Yoshimune Hiratsuka
  • Shusuke Hiragi
  • Masakazu Yamada

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.

Suggested Citation

  • Hiroshi Tamura & Rei Goto & Yoko Akune & Yoshimune Hiratsuka & Shusuke Hiragi & Masakazu Yamada, 2015. "The Clinical Effectiveness and Cost-Effectiveness of Screening for Age-Related Macular Degeneration in Japan: A Markov Modeling Study," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-20, July.
    • Handle: RePEc:plo:pone00:0133628
    DOI: 10.1371/journal.pone.0133628
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    References listed on IDEAS

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    1. Takeru Shiroiwa & Yoon‐Kyoung Sung & Takashi Fukuda & Hui‐Chu Lang & Sang‐Cheol Bae & Kiichiro Tsutani, 2010. "International survey on willingness‐to‐pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness?," Health Economics, John Wiley & Sons, Ltd., vol. 19(4), pages 422-437, April.
    2. Paul Mitchell & Lieven Annemans & Richard White & Meghan Gallagher & Simu Thomas, 2011. "Cost Effectiveness of Treatments for Wet Age-Related Macular Degeneration," PharmacoEconomics, Springer, vol. 29(2), pages 107-131, February.
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    1. Ra Ho & Lina D Song & Jin A Choi & Donghyun Jee, 2018. "The cost-effectiveness of systematic screening for age-related macular degeneration in South Korea," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-14, October.

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