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Simulation Contact Lenses for AMD Health State Utility Values in NICE Appraisals: A Different Reality

Butt, TJ; Crossland, M; West, P; Orr, S; Rubin, GS; (2014) Simulation Contact Lenses for AMD Health State Utility Values in NICE Appraisals: A Different Reality. British Journal of Ophthalmology 10.1136/bjophthalmol-2014-305802. Green open access

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Abstract

Background/aims: The National Institute for Health and Care Excellence (NICE) has recommended the use of ranibizumab for age-related macular degeneration (AMD) and for diabetic macular oedema (DMO) as part of its health technology appraisal (HTA) process. In the economic evaluations of both interventions, utility values were derived from members of the general public wearing contact lenses with a central opacity that was meant to simulate the blind spot experienced by many patients with advanced retinal disease. This paper tests the validity of the contact lens simulation, and finding it to be invalid, explores the impact on prior economic evaluations. Methods: Visual acuity, contrast sensitivity, and visual fields were assessed with and without simulation lenses in five healthy subjects with normal vision. Results: We identified important differences between the contact lens simulation and vision loss experienced by patients with AMD. The contact lens simulator did not cause the central scotoma which is characteristic of late-stage AMD and which leads to severe difficulty with everyday activities such as reading or recognising faces and objects. The contact lenses instead caused a reduction in retinal illumination experienced by the subjects as a general dimming across the retina. Conclusion: A contact lens with a central opacity does not simulate a central scotoma. The clinical differences between simulated and actual AMD suggests there has been an underestimation of the severity of AMD health states. This brings into question the validity of the economic evaluations of treatments for AMD and DMO used by NICE.

Type: Article
Title: Simulation Contact Lenses for AMD Health State Utility Values in NICE Appraisals: A Different Reality
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/bjophthalmol-2014-305802
Publisher version: http://bjo.bmj.com/
Language: English
Additional information: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
Keywords: Health state utility, Age-related macular degeneration, Preferences, United Kingdom
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Civil, Environ and Geomatic Eng
URI: https://discovery.ucl.ac.uk/id/eprint/1450248
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