Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data

Br J Ophthalmol. 2018 Apr;102(4):465-472. doi: 10.1136/bjophthalmol-2017-310939. Epub 2017 Aug 23.


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.

Keywords: age-related macular degeneration; cost-effectiveness; health economics; supplements.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antioxidants / economics
  • Antioxidants / therapeutic use*
  • Cost-Benefit Analysis
  • Dietary Supplements / economics*
  • Humans
  • Macular Degeneration / drug therapy*
  • Macular Degeneration / economics
  • Markov Chains
  • Middle Aged
  • Models, Economic
  • United Kingdom
  • Visual Acuity
  • Zinc / economics
  • Zinc / therapeutic use*


  • Antioxidants
  • Zinc