Cost effectiveness and cost utility of an organized screening programme for glaucoma

Abstract

ABSTRACT.Purpose: To assess the cost effectiveness and cost utility of an organized screening programme for glaucoma. The previous cost-effectiveness studies of screening show inconsistent results, and the cost utility of screening has not been assessed. Methods: An organized screening programme was simulated using Markov modelling in a population aged 50-79 years at 5 year intervals. The programme ended when the subjects reached the age of 80 years. The comparator was opportunistic case finding. The main outcome measures were cases and years of severe visual disability avoided, quality-adjusted life years (QALYs) gained and direct healthcare and non-healthcare costs. Results: The incremental cost of 1 year of avoided visual disability by screening was €32 602. The cost of one QALY gained by screening was €9023 with a discount rate of 5%. During the average 20 year time horizon considered, the cumulative incremental costs of screening in a population of 1 million people would be €30 million, producing 3360 incremental QALYs and 930 years of avoided visual disability for 701 persons. The results were sensitive to the estimates of several parameters, especially screening cost and specificity of screening tests (96-99% specificity required). Conclusion: An organized screening programme could be a cost-effective strategy especially in older age groups, in which screening is clearly more likely to be acceptable to decision makers at any level in terms of their willingness to pay for a QALY. Modelling includes some uncertainty especially concerning the specificity of diagnostic tests and screening cost.

Glaucoma: Confrontation visual field test using Bagolini striated glasses — a new screening method for detecting visual field defects

“…Important factors of cost utility of an organised screening program are screening costs and specificity [22]. There is no single gold-standard test for glaucoma diagnosis [21][22][23].…”

“…There is no single gold-standard test for glaucoma diagnosis [21][22][23]. It is always a synopsis of several examinations, which usually includes: best corrected visual acuity, slit-lamp examination, funduscopy, measurement of intraocular pressure, visual field tests (e.g.…”

Glaucoma: Present Challenges and Future Trends

“…Glaucoma is undiagnosed in 50% of cases in the western world, with higher figures in specific ethnicities, as demonstrated by several epidemiological studies (Baltimore Eye Survey, Rotterdam Eye Study, Blue Mountains Eye Study, Visual Impairment Project, Proyecto VER, and Latino Eye Study) and in up to 90% of cases in developing countries (Aravind Eye Study). On the other hand, glaucoma is paradoxically often overtreated: many subjects are treated although they have no real disease [7]. This strongly advocates a worldwide improvement in the accurate detection of the disease [8].…”

Trends in Glaucoma Disability in Ukraine

“…In recent years, we have witnessed an increase in the incidence of the pathology, which untimely diagnosis is associated with almost asymptomatic course in the early stages [5]. Glaucoma is characterized by high rates of morbidity, significant economic costs for the society and individual patients, as well as a significant reduction in the quality of life of patients [6].…”

“…Special attention should be paid to a discrepancy between prevalence of the disease and its positions in the structure of primary disability, which indicates the low quality of diagnostics provided by medical institutions [2,[5][6].…”