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Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data
  1. Aaron Y Lee1,
  2. Thomas Butt2,
  3. Emily Chew3,
  4. Elvira Agron4,
  5. Traci E Clemons5,
  6. Catherine A Egan2,6,
  7. Cecilia S Lee1,
  8. Adnan Tufail2,6
  9. on behalf of the UK EMR AMD Research Group
  1. 1 Department of Ophthalmology, University of Washington, Seattle, Washington, USA
  2. 2 Institute of Ophthalmology, University College London, London, UK
  3. 3 Division of Epidemiology and Clinical Research, National Institutes of Health, Bethesda, Maryland, USA
  4. 4 Division of Epidemiology and Clinical Applications, National Eye Institute, Bethesda, Maryland, USA
  5. 5 EMMES Corporation, Rockville, Maryland, USA
  6. 6 Moorfields Eye Hospital, London, UK
  1. Correspondence to Dr Adnan Tufail, Moorfields Eye Hospital NHS Trust, 162 City Road, London SE1 4TT, UK; adnan.tufail{at}


Aims To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4.

Methods A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. Setting: UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes.

Interventions Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. Main outcome measures: quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model.

Results For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient.

Conclusions The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy.

  • age-related macular degeneration
  • supplements
  • cost-effectiveness
  • health economics

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  • Contributors AYL, TB, CAE, EA, TEC, EC,CSL and AT participated in study codesigning, data analysis and evidence synthesis, and revising the manuscript. AYL, TB and AT also drafted the manuscript. THE UK EMR AMD Research Group TA, RA, SA, CB, CB, UC, LD, RL, RK, VK, KM, MM, SN, DS, MT, AV and WX participated in study data collection, evidence synthesis and revising the manuscript on previous UK EMR AMD data publications that fed the health economic model used.

  • Funding The health economic work was funded by the Macular Society. The data used in this analysis from the AREDS study was supported by the intramural programme funds and contracts from the National Eye Institute/National Institutes of Health (NEI/NIH), Department of Health and Human Services, Bethesda, Maryland. Contract No. HHS3N3260320053000073C. ADB Contract No. N013EY3530007. CSL was supported by NEI K23EY024921. Dr AYL was supported by Research to Prevent Blindness. CAE and AT received a proportion of funding from the Department of Health’s NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology. The collection of UK AMD EMR data used in the analysis was supported in part by unrestricted research award by Novartis Pharmaceuticals.

  • Competing interests None of the authors have any personal financial interest in AREDS or other nutritional supplement products. AT is a consultant for Allergan, Bayer, Chengdu Kanghong Biotech, Novartis and Roche.

  • Patient consent There is no data used that contain personal medical information about an identifiable living individual.

  • Ethics approval Caldicott Guardian Approval from each trust submitting data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Collaborators UK EMR AMD Research Group 3 Toks Akerele, Richard Antcliff, Stewart Armstrong, Clare Bailey, Catey Bunce, Usha Chakravarthy, Louise Downey, Robert L Johnston, Rehna Khan, Vineeth Kumar, Kaveri Mandal, Martin McKibbin, Salim Natha, Dawn Sim, Marie Tsaloumas, Atul Varma and Wen Xing.

  • Correction notice This article has been corrected since it was published Online First. The first two sentences of the Discussion section have been updated due to a factual error.