In the news: AREDS Supplements Cost-Effective; Vitamin D Reduces Pain in Chronic Widespread Pain

UK Study Finds AREDS Supplements Cost Effective in Category 4 AMD Patients

A UK multi-center study team concluded “AREDS supplements are a dominant cost-effective intervention for category 4 (advanced) AREDS patients, as they are both less expensive than standard care and more effective, and therefore should be considered for public funding.” (1)

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

To estimate cost savings, the researchers used data from the AREDS study as well as real world outcomes, drawing upon a prospective neovascular AMD (nAMD) database (the National Health Service Electronic Medical Record) containing 92,976 ranibizumab (anti-VEGF) treatment episodes.

Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements (AREDS1 and AREDS2 supplements were considered equivalent). 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.

The statistical model used to predict outcomes between supplemented and non-supplemented patients incorporated five different states of visual acuity and modeled AMD progression while assessing the probability of requiring anti-VEGF injections.

Category 4 patients with nAMD in one eye, showed a cost-savings of € 3,225 ($3,829) per patient over the lifetime of treatment vs. those not supplemented. Supplementation also increased QALYs by 0.16. The cost savings derived from requiring fewer anti-VEGF injections: over the lifetime of the patient, patients received an average 7.67 less intravitreal injections which are expensive.

In a UK survey 11% of patients with AMD who did not take AREDS supplements cited cost as a main factor. One public health strategy might be to actively provide AREDS supplements to Category 3 and 4 AMD patients. In the US, neither Medicare nor Medicaid cover patients’ cost of AREDS supplements to date.

Meta-Analysis: Vitamin D Reduces Pain Scores in Chronic Widespread Pain

Chronic non-specific widespread pain (CWP) including
fibromyalgia is characterized by widespread pain, reduced pain threshold, and multiple tender points on examination. Vitamin D has been proposed as an associated factor in CWP, and a recent meta-analysis of four randomized trials evaluated the effectiveness of vitamin D supplementation in managing CWP (2). Study outcome was assessed using visual analog scale of pain intensity.

Compared with those taking placebo, CWP patients receiving vitamin D treatment reported significantly lower VAS scores. Despite the fact that vitamin D decreased pain scores and improved pain, there was no association observed between changes in serum levels of the vitamin and VAS scores.

Possible mechanisms by which vitamin D may modulate pain pathways include decreasing inflammation and decreasing nitric oxide production, which affects neuro-transmission and vasodilation.

Comment: Marginal status or deficiency of vitamin D has been associated with a higher risk of dry eye in population health studies. Presence of ocular discomfort, dryness and grittiness is also one of the more common complaints in fibromyalgia. In addition, neuropathic ocular pain is associated with other chronic pain syndromes. It would be interesting to explore whether vitamin D has a role in reducing dry eye in fibromyalgia and/or neuropathic ocular pain.  

References

1. Lee, AY, et al. Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data. Br J Ophthalmol. Published Online First: Aug. 27, 2017.
2. Yong WC, et al. Effect of vitamin D supplementation in chronic widespread pain:a systematic review and meta-analysis. Clin Rheumatol. Aug 15, 2017 [Epub ahead of print].