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SRT reduced intravitreal anti-vascular endothelial growth factor (VEGF) re-treatments over two years of pro re nata ranibizumab, followed by two years of routine care. However, this resulted in worse best-corrected visual acuity (BCVA) in Years 3 and 4. This paper describes: associations between the EQ-5D vision bolt-on and visual acuity and patient-reported outcome measures; the impact of SRT on utilities with and without vision bolt-on; how the vision bolt-on affects the cost-effectiveness of SRT plus anti-VEGF versus anti-VEGF alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using data from the entire STAR trial cohort, we compared mean BCVA, EQ-5D-5L, and Visual Function Questionnaire-25 (VFQ-25) scores across the three levels of the EQ-5D vision bolt-on. We examined the relationship between BCVA and EQ-5D (with\/without the bolt-on) and VFQ-25. An economic evaluation estimated the cost-effectiveness of SRT from a UK national health service perspective over two years and over four years. This used prospective data on EQ-5D-5L and eye-related direct healthcare use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants reporting vision problems on the bolt-on had significantly worse BCVA, EQ-5D-5L, and VFQ-25 scores than those who did not. EQ-5D utilities (with and without the bolt-on) increased with BCVA but showed weaker correlations than VFQ-25 composite scores. Quality-adjusted life years (QALYs) did not differ significantly between treatment groups, with or without the bolt-on. The economic evaluation suggested SRT would reduce healthcare costs by \u00a3404 (95% CI: -\u00a31282 to \u00a32092) per patient at a four-year time horizon. The probability of SRT plus anti-VEGF being cost-effective at a \u00a320,000 per QALY threshold was 65% at a four-year time horizon. Sensitivity analyses confirmed the robustness of incorporating the vision bolt-on did not alter the cost-effectiveness conclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Resource use data from the trial and routine follow-up could be used for future economic models. The vision bolt-on captured quality of life differences between participants but may not be sufficiently responsive to visual acuity decline in trials where only one eye is treated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ISRCTN12884465, registration date 01\/12\/2014.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12955-025-02457-w","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:52:03Z","timestamp":1784040723000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["EQ-5D vision bolt-on in macular degeneration: associations with visual measures and effect on utility differences and cost-effectiveness of stereotactic radiotherapy"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8135-3956","authenticated-orcid":false,"given":"Xuemin","family":"Zhu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wordsworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chan Ning","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hatem A.","family":"Wafa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanzhong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riti","family":"Desai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Ramazzotto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barnaby C.","family":"Reeves","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy L.","family":"Jackson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Dakin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the STAR Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"2457_CR1","unstructured":"National Institute for Clinical Excellence. 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All participants provided written informed consent prior to enrolment. The study adhered to the principles of the Declaration of Helsinki and followed CONSORT guidelines. Oversight was maintained by an independent Trial Steering Committee (TSC) and a Data Monitoring and Ethics Committee.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article\u2019s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article\u2019s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit\n                      \n                      .","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Rights and permissions"}},{"value":"Oraya\/Zeiss provided free use of the SRT device at the STAR National Treatment Centres. BCR, YW, HAW, SW, HD and XZ declare no competing interests. TLJ is a consultant or adviser to 2CTech, Alcon, Bayer, Dutch Ophthalmic Research Centre, iLumen, Opthea, Outlook Therapeutics, Oxurion, Pfizer, and Regeneron. He has received conference support from Roche, and an advisory board payment from Oraya in 2013. His employer received free use of equipment from LKC for an investigator-initiated trial, and site payments from various trial sponsors for patient enrolment on commercial trials, including trials of nAMD. HD and SW are financially supported in part by the National Institute for Health and Care Research Oxford Biomedical Research Centre. CNL has undertaken contracting work for Opthea. TLJ, LR, RD, and CNL\u2019s NHS employer receives site fees for patients enrolled on commercial retinal trials of AMD and other conditions.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"93"}}