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Original Investigation
May 2017

Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System

Author Affiliations
  • 1NORC at the University of Chicago, Chicago, Illinois
  • 2The Emmes Corporation, Rockville, Maryland
  • 3Wills Eye Hospital, Bryn Mawr, Pennsylvania
  • 4The Chartis Group, Chicago, Illinois
JAMA Ophthalmol. 2017;135(5):452-459. doi:10.1001/jamaophthalmol.2017.0255
Key Points

Question  What are some economic considerations of home telemonitoring of age-related macular degeneration?

Findings  In this economic analysis using a simulation model, home telemonitoring was considered to be cost-effective in developed countries for patients at high risk for the neovascular form of age-related macular degeneration ($35 663 per quality-adjusted life-year gained). Home monitoring for age-related macular degeneration currently would cost society $907 and be cost saving for patients, incurring $1312 in government expenditures during 10 years.

Meaning  This simluation model suggests that supplementing usual care with home telemonitoring for patients at high risk for developing neovascular age-related macular degeneration not only reduces risk of vision loss but also is cost-effective, although incurring net costs for Medicare.

Abstract

Background  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.

Objectives  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.

Interventions  Home telemonitoring of patients with AMD for early detection of CNV vs usual care.

Main Outcomes and Measures  Incremental cost-effectiveness ratio, net present value of lifetime societal costs, and 10-year nominal government expenditures.

Result  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.

Conclusions and Relevance  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.

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