Zinc plus antioxidant: A cost-effective solution to macular degeneration?

© iStock/ sdigital

A formula supplement containing anti-oxidants plus zinc appears to be cost-effective in slowing the progression of the ‘wet’ form of the most common degenerative eye disease, finds a new study in British Journal of Ophthalmology.

The cost savings and effectiveness of the supplement in advanced (category 4) cases of neovascular (wet-form) Age Related Macular Degeneration (nAMD) are such that their use should be considered in public health policy, recommend the multi-centre study team on behalf of the UK Electronic Medical Record (EMR) AMD Research Team.

Category 4 individuals who already had nAMD in one eye, showed a cost saving of nearly €3250 (£3000) per patient over the lifetime of treatment, compared to those not given supplements. The Age Related Eye Disease Study (AREDS) formula supplements also increased quality-adjusted life years (QALYs) by 0.16.

The cost savings derive from patients needing fewer anti-vascular endothelial growth factor (VEGF) injections, which are not only expensive but are linked to increased inflammation and possibly stroke risk.

“AREDS supplements are a dominant cost-effective intervention for category 4 AREDS patients, as they are both less expensive than standard care and more effective, and therefore should be considered for public funding,” wrote lead researcher Dr. Adnan Tufail.

The researchers estimated that lifetime cost savings in anti-VEGF injections for a one-year cohort of nAMD patients would be around €141 million (£131 million), compared with a cost of €7.5 million (£7.0 million) for supplements.

Savings would also be made in patients with Category 3 (intermediate) AMD in both eyes. However, the case for public funding was not as compelling and therefore “would depend on the healthcare system willingness to pay,” the researchers added.

Study Details

Data was used from the AREDS study and also real-world outcomes using a prospective multicentre nAMD database (National Health Service EMR) involving ranibizumab (anti-VEGF) injections.

The study examined the use of AREDS formulation 1 and formulation 2 supplements.

AREDS 1 contained 80milligrams (mg) zinc, 2 mg copper, 500 mg vitamin C, 15 mg beta-carotene, 400 IU vitamin E.

AREDS 2 reduced the amount of zinc to 25 mg, excluded beta-carotene (due to potential higher cancer risk in smokers), and added 10 mg lutein, 2 mg zeaxanthin, 1000 mg omega-3 fatty acids (650 mg docosahexaenoic acid and 350 mg eicosapentaenoic acid).

The researchers used the Markov Model statistical method to predict outcomes between supplemented and non-supplemented individuals. The model incorporated five different states of visual acuity and modelled the progression of AMD while assessing the probability of needing anti-VEGF injections. The costs of these injections and visits to an eye specialist were incorporated into the economic model.

Conclusion

These findings are consistent with previous research demonstrating the effectiveness of AREDS supplements in category 3 and 4 AMD patients. Consequently, the researchers advocate the use of supplements to reduce the necessity for ranibizumab injections, which is the standard NHS treatment for AMD.

“Given the burden and cost of treatment, prevention of nAMD seems, therefore, an attractive strategy to avoid the chronic and costly anti-VEG therapies and preserve visual function,” they conclude.

Source:  British Journal of Ophthalmology
Published online, doi: 10.1136/bjophthalmol-2017-310939
“Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data”
Authors:   Aaron Y. Lee, Adnan Tufail et al.

Related News

iStock / KatarzynaBialasiewicz

Battling malnutrition in elderly care: Study sets out economic arguments for oral supplementation

Cochrane review that belittled carotenoids' role in slowing AMD didn't value AREDS II result highly enough, researchers say

Cochrane review that belittled carotenoids' role in slowing AMD didn't value AREDS II result highly enough, researchers say

AMD is a leading cause of vision loss among in people over 50. Image © iStock / Photokanok

Could effectiveness of AREDS formula differ by genotype?

"The results should not be misinterpreted as a lack of an effect(s), rather a failure to detect an effect" - Dr Harry Rice, GOED

AREDS2 data finds omega-3s ineffective for heart health, but subgroup analysis suggests big benefits for healthy individuals

Lutein + zeaxanthin may reduce risk of progression to advanced AMD, compared to original AREDS formula

Lutein + zeaxanthin may reduce risk of progression to advanced AMD, compared to original AREDS formula

Related Products

See more related products

Submit a comment

Your comment has been saved

Post a comment

Please note that any information that you supply is protected by our Privacy and Cookie Policy. Access to all documents and request for further information are available to all users at no costs, In order to provide you with this free service, William Reed Business Media SAS does share your information with companies that have content on this site. When you access a document or request further information from this site, your information maybe shared with the owners of that document or information.