The clinical effectiveness and cost- effectiveness of screening for age-related macular degeneration in Japan: A Markov modeling study

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

研究成果: Article

12 引用 (Scopus)

抄録

Objective: To investigate the cost-effectiveness of screening and subsequent intervention for agerelated 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 qualityadjusted 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.

元の言語English
記事番号e0133628
ジャーナルPLoS One
10
発行部数7
DOI
出版物ステータスPublished - 2015 7 27
外部発表Yes

Fingerprint

Macular Degeneration
cost effectiveness
Cost effectiveness
Cost-Benefit Analysis
Japan
Screening
screening
Prodromal Symptoms
Choroidal Neovascularization
signs and symptoms (animals and humans)
Blindness
blindness
angiogenesis
eyes
Intravitreal Injections
Photochemotherapy
therapeutics
Photodynamic therapy
vascular endothelial growth factors
macular degeneration

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

これを引用

The clinical effectiveness and cost- effectiveness of screening for age-related macular degeneration in Japan : A Markov modeling study. / Tamura, Hiroshi; Goto, Rei; Akune, Yoko; Hiratsuka, Yoshimune; Hiragi, Shusuke; Yamada, Masakazu.

:: PLoS One, 巻 10, 番号 7, e0133628, 27.07.2015.

研究成果: Article

Tamura, Hiroshi ; Goto, Rei ; Akune, Yoko ; Hiratsuka, Yoshimune ; Hiragi, Shusuke ; Yamada, Masakazu. / The clinical effectiveness and cost- effectiveness of screening for age-related macular degeneration in Japan : A Markov modeling study. :: PLoS One. 2015 ; 巻 10, 番号 7.
@article{3c8872d594164990be9702c94b8eace6,
title = "The clinical effectiveness and cost- effectiveness of screening for age-related macular degeneration in Japan: A Markov modeling study",
abstract = "Objective: To investigate the cost-effectiveness of screening and subsequent intervention for agerelated 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 qualityadjusted 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.",
author = "Hiroshi Tamura and Rei Goto and Yoko Akune and Yoshimune Hiratsuka and Shusuke Hiragi and Masakazu Yamada",
year = "2015",
month = "7",
day = "27",
doi = "10.1371/journal.pone.0133628",
language = "English",
volume = "10",
journal = "PLoS One",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "7",

}

TY - JOUR

T1 - The clinical effectiveness and cost- effectiveness of screening for age-related macular degeneration in Japan

T2 - A Markov modeling study

AU - Tamura, Hiroshi

AU - Goto, Rei

AU - Akune, Yoko

AU - Hiratsuka, Yoshimune

AU - Hiragi, Shusuke

AU - Yamada, Masakazu

PY - 2015/7/27

Y1 - 2015/7/27

N2 - Objective: To investigate the cost-effectiveness of screening and subsequent intervention for agerelated 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 qualityadjusted 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.

AB - Objective: To investigate the cost-effectiveness of screening and subsequent intervention for agerelated 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 qualityadjusted 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.

UR - http://www.scopus.com/inward/record.url?scp=84941903245&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84941903245&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0133628

DO - 10.1371/journal.pone.0133628

M3 - Article

C2 - 26214804

AN - SCOPUS:84941903245

VL - 10

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 7

M1 - e0133628

ER -