Wittenborn John S, Clemons Traci, Regillo Carl, Rayess Nadim, Liffmann Kruger Danielle, Rein David
NORC at the University of Chicago, Chicago, Illinois.
The Emmes Corporation, Rockville, Maryland.
JAMA Ophthalmol. 2017 May 1;135(5):452-459. doi: 10.1001/jamaophthalmol.2017.0255.
Medicare recently approved coverage of home telemonitoring for early detection of incident choroidal neovascularization (CNV) among patients with age-related macular degeneration (AMD), but no economic evaluation has yet assessed its cost-effectiveness and budgetary impact.
To evaluate a home-based daily visual-field monitoring system using simulation methods and to apply the findings of the Home Monitoring of the Eye study to the US population at high risk for wet-form AMD.
DESIGN, SETTING, AND PARTICIPANTS: In this economic analysis, an evaluation of the potential cost, cost-effectiveness, and government budgetary impact of adoption of a home-based daily visual-field monitoring system among eligible Medicare patients was performed. Effectiveness and visual outcomes data from the Age-Related Eye Disease Study 2 Home Monitoring of the Eye study, treatment data from the Wills Eye Hospital Treat & Extend study, and AMD progression data from the Age-Related Eye Disease Study 1 were used to simulate the long-term effects of telemonitoring patients with CNV in one eye or large drusen and/or pigment abnormalities in both eyes. Univariate and probabilistic sensitivity analysis and an alternative scenario using the Treat & Extend study control group outcomes were used to examine uncertainty in these data and assumptions.
Home telemonitoring of patients with AMD for early detection of CNV vs usual care.
Incremental cost-effectiveness ratio, net present value of lifetime societal costs, and 10-year nominal government expenditures.
Telemonitoring of patients with existing unilateral CNV or multiple bilateral risk factors for CNV (large drusen and retinal pigment abnormalities) incurs $907 (95% CI, -$6302 to $2809) in net lifetime societal costs, costs $1312 (95% CI, $222-$2848) per patient during 10 years from the federal government's perspective, and results in an incremental cost-effectiveness ratio of $35 663 (95% CI, cost savings to $235 613) per quality-adjusted life-year gained.
Home telemonitoring of patients with AMD who are at risk for CNV was cost-effective compared with scheduled examinations alone. Monitoring patients with existing CNV in one eye is cost saving, but monitoring is generally not cost-effective among patients with low risk of CNV, including those with no or few risk factors. With Medicare coverage, monitoring incurs budgetary expenditures for the government but is cost-saving for patients at high risk of AMD. Monitoring could be cost saving to society if monitoring reduced the frequency of scheduled examinations or led to a reduction of one or more injections of ranibizumab.
医疗保险最近批准了对年龄相关性黄斑变性（AMD）患者进行家庭远程监测，以早期发现脉络膜新生血管（CNV），但尚未有经济评估来评估其成本效益和预算影响。
使用模拟方法评估基于家庭的日常视野监测系统，并将眼部家庭监测研究的结果应用于湿性AMD高风险的美国人群。
设计、设置和参与者：在这项经济分析中，对符合条件的医疗保险患者采用基于家庭的日常视野监测系统的潜在成本、成本效益和政府预算影响进行了评估。来自年龄相关性眼病研究2眼部家庭监测研究的有效性和视觉结果数据、威尔斯眼科医院治疗与扩展研究的治疗数据以及年龄相关性眼病研究1的AMD进展数据，用于模拟对单眼患有CNV或双眼有大的玻璃膜疣和/或色素异常的患者进行远程监测的长期效果。使用单因素和概率敏感性分析以及使用治疗与扩展研究对照组结果的替代方案来检验这些数据和假设中的不确定性。
对AMD患者进行家庭远程监测以早期发现CNV与常规护理。
增量成本效益比、终身社会成本的净现值和10年名义政府支出。
对现患单侧CNV或有多个双侧CNV危险因素（大的玻璃膜疣和视网膜色素异常）的患者进行远程监测，终身社会成本净支出为907美元（95%CI，-6302美元至2809美元），从联邦政府角度来看，每位患者在十年期间成本为1312美元（95%CI，222美元至2848美元），每获得一个质量调整生命年的增量成本效益比为35663美元（95%CI，成本节约至235613美元）。
与仅进行定期检查相比，对有CNV风险的AMD患者进行家庭远程监测具有成本效益。对单眼现患CNV的患者进行监测可节省成本，但在CNV低风险患者中，包括那些无或有很少危险因素的患者，监测通常不具有成本效益。有了医疗保险覆盖，监测会给政府带来预算支出，但对AMD高风险患者来说是节省成本的。如果监测减少了定期检查的频率或导致雷珠单抗注射减少一次或多次，那么监测对社会可能是节省成本的。
