New findings from a study published in Ophthalmology and Therapy demonstrated the efficacy and cost-effective nature of daily oral supplementation of 20 mg Zeaxanthin (Zx) in patients with unilateral neovascular age-related macular degeneration (nAMD) to reduce fellow-eye long-term incidence.
Give me some background first.
A previous 2-year randomized clinical trial (NCT01527435) led by the same research team showed that oral Zx supplementation for patients with unilateral nAMD reduced fellow-eye incidence from 23% to 6% (p=0.02).
Oral Zx supplementation with triple therapy (photodynamic therapy/intravitreal bevacizumab/intravitreal dexamethasone) vs. triple therapy alone conferred a greater gain in quality-adjusted life-years (QALY)—a measure of quality of life—for less cost than triple therapy alone due to decreased fellow-eye nAMD conversion.
Now talk about the latest study.
In this 5-year, case-control, follow-up study, unilateral nAMD patient outcomes were recorded for those who maintained Zx-supplementation with triple therapy for > 5 years.
Of the 227 patients with unilateral nAMD and Zx supplementation, 202 (90%) had 5-year follow-ups.
What was this compared to?
Investigators compared this information to atrophic fellow-eye conversion data from the Comparison of AMD Treatments Trials (CATT) study (NCT00593450), which assessed the 5-year efficacy of ranibizumab and bevacizumab to treat nAMD.
Anything else?
The research team also performed an 11-year life expectancy cost-utility analysis (CUA) using a 3% discount rate and 2020 US real dollars.
Findings?
Using a Kaplan-Meier model, the fellow-eye nAMD 5-year conversion incidence was 22% (49/227) vs. 48% (167/348) in the CATT control data (p<0.0001)—a marked 54% decrease in the incidence of fellow-eye conversion.
What about the CUA?
In the 11-year cost-utility model, it was estimated that for years 6 to 11, there was a 0.42 (7.7%) QALY gain.
This included 3 months of life saved per patient due to decreased nAMD fellow-eye conversion.
Go on…
From a direct ophthalmic medical cost perspective, the incremental cost-utility ratio (CUR) was -$576/QALY. And from a societal cost perspective, it led to a CUR of -$125,071/QALY.
In this model, each participant with Zx supplementation experienced a 7.2% QALY gain.
What does this mean?
Hypothetically, Zx supplementation for all 2020 US unilateral nAMD cases would have saved society (primarily patients) $6 billion over 11 years.
Within this model, Zx costs demonstrated a 1531% return on investment (ROI) or 31.3% annual ROI.
Expert opinion?
According to the study authors, “Our incremental CUA demonstrates that nAMD second-eye prevention is superior to treatment in baseline unilateral nAMD cases.”
“Not only does Zx supplementation prevention yield a greater QALY gain versus no supplementation, but it is less costly and results in a large ROI for the Zx supplementation cost,” they added.
Take home.
Patients with unilateral nAMD on long-term oral Zx supplementation experienced a reduction in fellow-eye nAMD conversion compared to patients who did not receive Zx supplementation at 5 years.
Additionally, this treatment was proven to be more cost-effective by conventional U.S. standards, likely preventing loss of life-years due to poor vision.