nAMD: Systematic review and economic modelling of Optical Coherence Tomography (OCT) for the diagnosis, monitoring and guiding of treatment for neovascular Age-related Macular Degeneration
Neovascular age-related macular degeneration (nAMD) is the most common cause of visual impairment in the UK with between 13,000 and 37,000 new cases every year. Since 2008, patients have been able to receive effective treatment with new (anti-VEGF) drugs. Treatment is given as monthly injections, initially, into the eye and then tailored to the individual. The disease status is reviewed every month and treatment administered if the disease is deemed active. This frequent monitoring has enormously increased the workload of speciality eye clinics, which already account for over 10% of all outpatient activity in the NHS.
Diagnosis of nAMD is done by ophthalmologists who interpret imaging tests. Fluorescein angiography (FA) – a time consuming and invasive test – is considered the reference standard. OCT, a relatively new test that is currently used in addition to FA to diagnose nAMD, is non-invasive, safe and easier to interpret, and could potentially replace FA. In addition, OCT is used for monitoring throughout the UK but its accuracy has not been determined.
This project included systematic reviews of the literature and a model based economic evaluation.
Prospero record for this study. (Prospero is an international prospective register of systematic reviews in health and social care).
Health Technology Assessment project portfolio for this record.
Outcome and Translation
There has already been a shift in the diagnostic and monitoring pathways for nAMD caused by the adoption of OCT. At the diagnostic stage, OCT is currently used in addition to FA, whereas for monitoring it has virtually replaced FA.
The evidence suggests that using OCT as the only test for monitoring patients with nAMD and detecting activity would, potentially, result in a substantial proportion of patients receiving treatment unnecessarily.
The results help better planning and provision of the different treatment options for people with nAMD and identified areas where further research is needed.
HERU researchers involved in this research project: Rodolfo Hernández
External Collaborators: G Mowatt, C Ramsay, A Azuara-Blanco, D Clark (HSRU, University of Aberdeen); N Lois (NHS Grampian); J Burr (University of St. Andrews)
Mowatt, G., Hernandez, R., Castillo, M., Lois, N., Fraser, C., Aremu, O., Amoaku, W., Burr, J. M., Lotery, A., Ramsay, C. and Azuara-Blanco, A. (2014) Optical coherence tomography for the diagnosis, monitoring, and guiding of treatment for neovascular age-related macular degeneration: a systematic review and economic evaluation. Final grant report submitted to the NIHR HTA programme, Aberdeen: HERU.
Mowatt, G., Hernandez, R., Castillo, M., Lois, N., Elders, A., Fraser, C., Aremu, O., Amoaku, W., Burr, J., Lotery, A., Ramsay, C. and Azuara-Blanco, A. (2014) 'Optical coherence tomography for the diagnosis, monitoring and guiding of treatment for neovascular age-related macular degeneration: a systematic review and economic evaluation', Health Technology Assessment, 18(69).
Castillo, M. M., Mowatt, G., Elders, A., Lois, N., Fraser, C., Hernández, R., Amoaku, W., Burr, J. M., Lotery, A., Ramsay, C. R. and Azuara-Blanco, A. (2015) 'Optical Coherence Tomography for the monitoring of neovascular age-related macular degeneration: a systematic review', Ophthalmology, 122(2), 399-406.
Hernández, R., Lois, N., Elders, A., Burr, J.M., Ramsay, C. and Azuara-Blanco, A. (2017) 'Optical coherence tomography for neovascular AMD: economic evaluation', Health Technology Assessment international (HTAi) Annual Meeting, Rome, Italy, 17-21 June 2017.