Age-related macular degeneration: economic burden and value-based medicine analysis+

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Abstract

Age-related macular degeneration (AMD) is a major public health problem. It can be estimated that 17 100 new cases of neovascular (wet) AMD and 180 000 new cases of geographic-atrophy (dry) AMD occur in Canada annually. In addition to having a devastating effect on patients' lives, the condition causes significant adverse consequences for the economy. The deleterious effect of AMD on quality of life is markedly underestimated by ophthalmologists who treat patients with AMD, by non-ophthalmic physicians and by the public. In fact, patients with different degrees of severity of AMD have a perceived impairment of their quality of life that is 96% to 750% greater than the impairment estimated by treating ophthalmologists. Mild AMD causes a 17% decrease in the quality of life of the average patient, a decrease similar to that encountered with symptomatic human immunodeficiency virus infection or moderate cardiac angina. Moderate AMD produces a 40% decrease in quality of life, a decrease similar to that associated with permanent renal dialysis or severe cardiac angina. Very severe AMD causes a 63% decrement in quality of life, a decrease similar to that encountered with advanced prostatic cancer with uncontrollable pain or a severe stroke that leaves a person bedridden, incontinent and requiring constant nursing care. The adverse economic consequences of AMD include an annual $2.6 billion negative impact on Canada's gross domestic product. The return on investment is high for both current AMD therapies and research into new treatment modalities.

Résumé

La dégénérescence maculaire liée à l’âge (DMLA) est un important problème de santé publique. On estime que le Canada compte, par année, 17 100 nouveaux cas de DMLA néovasculaire (exsudative) et 180 000 nouveaux cas de la forme atrophique de DMLA (sèche). En plus de ravager la vie des patients, la maladie a d’importants effets négatifs sur l’économie. Les ophtalmologistes qui soignent ce type de patients, les autres médecins et le public sous-estiment nettement les conséquences délétères de la DMLA sur la qualité de vie. En effet, les patients qui ont une DMLA, quel qu’en soit le degré de sévérité, estiment que leur qualité de vie a baissé dans une proportion de 96% à 750% plus importante que la perception qu’en ont les ophtalmologistes traitants. Une DMLA légère entraîne une baisse de 17% de la qualité de vie chez le patient moyen, comme ceux qui ont l’infection symptomatique par le virus d’immunodéficience humaine ou une angine modérée. Une DMLA modérée fait baisser de 40% la qualité de vie, comme le font la dialyse rénale permanente ou une angine sévère. Une DMLA très sévère entraîne une baisse de 63% de la qualité de vie, semblable à celle qu’entraîne un cancer avancé de la prostate avec douleur incontrôlable ou un accident cérébrovasculaire grave qui laisse une personne alitée, incontinente et nécessitant des soins constants. Les conséquences négatives de la DMLA sur l’économie comprennent un impact négatif de 2,6 milliards de dollars sur le produit intérieur brut du Canada. Pour ce qui est des soins actuels de la DMLA et de la recherche de nouveaux modes de traitement, le rendement sur l’investissement est donc élevé.

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      The SIGN level of evidence was B (n = 3) or C (n = 3; ie, well-conducted case-control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal) (Supplemental Table III). For risk of bias, only 1 study complied with ≥30% of criteria41; none of the studies assessed the economic impact of treatment, so some questions were not applicable (Supplemental Table V). The limitations of the reviewed studies were not expected to significantly affect major outcomes.

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    This article has been peer-reviewed.

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