Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan.
Jpn J Ophthalmol. 2022 Jan;66(1):19-32. doi: 10.1007/s10384-021-00890-0. Epub 2022 Jan 7.
To investigate the effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan.
Best-case-scenario analysis using a Markov model.
The clinical effectiveness and cost-effectiveness of screening for AMD were assessed by calculating the reduction proportion of blindness and the incremental cost-effectiveness ratio (ICER). The Markov model simulation began at screening at the age of 40 years and ended at screening at the age of 90 years. The first-eye and second-eye combined model assumed annual state-transition probabilities in the development and treatment of AMD. Data on prevalence, morbidity, transition probability, utility value, and treatment costs were obtained from previously published reports. Sensitivity analysis was performed to assess the influence of the parameters.
In the base-case analysis, screening for AMD every 5 years, beginning at age 40 years and ending at age 74 years (reflecting the screening ages of the current Japanese legal "Specific Health Checkups") showed a decrease of 40.7% in the total number of blind patients. The screening program reduced the number of blind people more than did the additional AREDS/AREDS2 formula supplement intake. However, the ICER of screening versus no screening was ¥9,846,411/QALY, which was beyond what people were willing to pay (WTP) in Japan. Sensitivity analysis revealed that neither OCT nor AI improved the ICER, but the scenario in which the prevalence of smoking decreased by 30% improved the ICER (¥4,655,601/QALY) to the level under the WTP.
Ophthalmologic screening for AMD is highly effective in reducing blindness but is not cost-effective, as demonstrated by a Markov model based on real-world evidence from Japan.
研究日本年龄相关性黄斑变性（AMD）的筛查及后续干预的效果。
使用马尔可夫模型进行最佳情况分析。
通过计算失明减少比例和增量成本效益比（ICER），评估 AMD 筛查的临床效果和成本效益。Markov 模型模拟从 40 岁开始进行 AMD 筛查，一直持续到 90 岁。双眼联合模型假设 AMD 的发展和治疗的年度状态转移概率。关于患病率、发病率、转移概率、效用值和治疗成本的数据均来自先前发表的报告。进行敏感性分析以评估参数的影响。
在基础情况分析中，每 5 年对 AMD 进行一次筛查，从 40 岁开始，一直持续到 74 岁（反映了日本现行法定“特定健康检查”的筛查年龄），可以减少 40.7%的总盲人数。与额外补充 AREDS/AREDS2 配方相比，筛查方案可减少盲人数。然而，筛查与不筛查的 ICER 为 984.6411 日元/QALY，超出了日本人的意愿支付水平（WTP）。敏感性分析表明，OCT 或 AI 都不能提高 ICER，但如果吸烟率降低 30%，则可以提高 ICER（465.5601 日元/QALY），达到 WTP 以下的水平。
基于日本真实世界证据的马尔可夫模型显示，眼科 AMD 筛查可有效降低失明率，但在成本效益方面不具优势。
