Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System Interview with:
John Wittenborn

Senior research scientist
NORC’s Public Health Analytics
University of Chicago What is the background for this study? What are the main findings?

Response:The emergence of anti-VEGF treatment for wet-form AMD (choroidal neovascularization) has had a dramatic impact on preserving vision for many Americans. However, community-based studies show that most patients are not diagnosed with wet-form AMD until they have already lost a significant, and largely unrecoverable amount of their vision.  Early detection of wet-form AMD is key to effective treatment and the preservation of vision. The ForeseeHome telemonitoring technology provides patients with a means to check their own eyes on a daily basis to detect the earliest signs of vision loss from wet-form AMD.

This is a novel technology that has the potential to improve visual health outcomes for AMD patients.  A prior clinical trial (the AREDS-2 HOME study) demonstrated that this technology can detect wet-form AMD earlier, and with less vision loss than standard care alone. However, that is exactly where that study ended as it reported no cost information nor follow-up. Since the end of this study, the device has been cleared by the FDA and approved for reimbursement by Medicare for certain higher risk patients, but no study has yet considered the long-term implications of adoption of this technology.

In our analysis, we use a computer simulation model to essentially estimate what will come next, after patients realize earlier detection of wet-form AMD by utilizing home monitoring. Basically, we follow simulated patients from the time they begin monitoring for the rest of their lives, recording the likely impacts of home monitoring on patients’ long term outcomes including visual status, costs and quality of life.

We find that home telemonitoring among the population indicated for reimbursement by Medicare would cost $35,663 per quality adjusted life year (QALY) gained.  Medicare would expect to incur $1,312 in net budgetary costs over 10 years for each patient who initiates monitoring.  However, Medicare patients may expect to achieve lifetime net savings when accounting for the chance of avoided vision loss and its associated costs later in life. What should readers take away from your report?

Response: Previously, telehealth was often considered only as a means to reach rural or underserved populations. However, emerging telehealth technology promises to enhance standard of care for all patients, while also being cost-effective. ForeseeHome may turn out to be but an early example of a class of technology that can dramatically increase monitoring and compliance rates with minimal burden to patients and payers. What recommendations do you have for future research as a result of this study?

Response: In many ways we, and the clinical trial on which our results are largely based erred on the conservative. The clinical trial included unrealistically high rates of examinations in the control group, and then ended early as soon as effectiveness thresholds were met. For our part, we do not consider likely impacts such as fewer scheduled exams or lower treatment intensity following early detection. Either of these eventualities could make this technology substantially cost-saving for even lower risk patients.

In many cases, studies find results that cannot be matched in the real world where barriers to care and lower compliance mitigate benefits. However, I suspect that longer-term outcomes for telemonitoring  Age-Related Macular Degeneration patients in the real world may actually turn out better that our results would indicate. As such, a study on community implementation of home telemonitoring could provide a clearer picture of which patients would best benefit from this technology. Thank you for your contribution to the community.


Wittenborn JS, Clemons T, Regillo C, Rayess N, Liffmann Kruger D, Rein D. Economic Evaluation of a Home-Based Age-Related Macular Degeneration Monitoring System. JAMA Ophthalmol. Published online March 30, 2017. doi:10.1001/jamaophthalmol.2017.0255

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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