VALUE-BASED OPHTHALMOLOGY Cost utility of screening and treatment for early age related macular degeneration with zinc and antioxidants

Aim: To assess the cost effectiveness of high dose zinc and antioxidants for delaying and reducing the progression of early age related macular degeneration (AMD). Background: AMD is the leading cause of severe vision impairment and blindness in older people throughout the developed world. It currently affects around 420 000 people in the United Kingdom. Methods: A cost utility analysis (CUA) was conducted to estimate the cost per quality adjusted life year (QALY) for screening a cohort of men and women, aged 55 years and over, for early AMD and then treating them with zinc and antioxidants. The incremental CUA was based on a decision analytic model, comparing screening with a no screening comparator (current practice). Extensive one way sensitivity analysis of parameters was conducted to determine the robustness of the model. Results: In this model the cost effectiveness of screening for early AMD was £22 722 per quality adjusted life year (QALY) saved. The cost per QALY decreased to £18 948 if photodynamic therapy with verteporfin savings were included. Conclusions: Screening for, and prophylactic treatment of, early AMD is estimated to cost around £22 700 per QALY saved. This cost falls within accepted levels to warrant further investigation. These findings have implications for ophthalmic practice and healthcare planning.