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Japanese Journal of Ophthalmology
Published in: Japanese Journal of Ophthalmology 1/2022

01-01-2022 | Artificial Intelligence | Clinical Investigation

Real-world effectiveness of screening programs for age-related macular degeneration: amended Japanese specific health checkups and augmented screening programs with OCT or AI

Authors: Hiroshi Tamura, Yoko Akune, Yoshimune Hiratsuka, Ryo Kawasaki, Ai Kido, Masahiro Miyake, Rei Goto, Masakazu Yamada

Published in: Japanese Journal of Ophthalmology | Issue 1/2022

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Abstract

Purpose

To investigate the effectiveness of screening and subsequent intervention for age-related macular degeneration (AMD) in Japan.

Study design

Best-case-scenario analysis using a Markov model.

Methods

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.

Results

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.

Conclusions

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.
Appendix
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Metadata
Title
Real-world effectiveness of screening programs for age-related macular degeneration: amended Japanese specific health checkups and augmented screening programs with OCT or AI
Authors
Hiroshi Tamura
Yoko Akune
Yoshimune Hiratsuka
Ryo Kawasaki
Ai Kido
Masahiro Miyake
Rei Goto
Masakazu Yamada
Publication date
01-01-2022
Publisher
Springer Japan
Published in
Japanese Journal of Ophthalmology / Issue 1/2022
Print ISSN: 0021-5155
Electronic ISSN: 1613-2246
DOI
https://doi.org/10.1007/s10384-021-00890-0

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