Original ResearchCost-effectiveness and cost utility of community screening for glaucoma in urban India
Section snippets
Objectives
Glaucoma contributes to 0.6 million disability-adjusted life years (DALYs) or 1.96% of the overall burden of diseases in India.1 A recent population-based study using modern techniques for detecting glaucoma suggested 11.2 million persons aged 40 years and older are affected due to glaucoma in India; primary open-angle glaucoma (POAG) affecting 6.48 million persons and primary angle-closure glaucoma (PACG) affecting 2.54 million persons.2 Around 27.6 million persons were estimated to have some
Screening programme
A hypothetical screening intervention programme (Fig. 1) was designed for glaucoma detection after discussions with a glaucoma specialist and ophthalmic epidemiologist. The screening protocol has been described in detail elsewhere.21 It is to be noted that, due to the higher proportion of cases in the population, only POAG and angle-closure disease were the focus for the screening programme; secondary and other forms of glaucoma were not to be considered.
Table 1 provides the summary of the
Structure of the decision model
Based on the screening protocol (Fig. 1) and the treatment pathway (Fig. 2), a decision-analytic model (Fig. 3) was developed using TreeAge Pro (version 2015, MA, USA) to model events, costs and treatment pathway of glaucoma with and without screening for the relevant patient group, i.e. population aged between 40 and 69 years. The main outcomes of the model studied were (a) total net cost of each strategy, (b) additional cases treated in the screening arm, (c) cost per quality-adjusted life
Results
The decision-analytic model suggests that, in current practice (i.e. without a screening programme but with some opportunistic case finding), the total cost of glaucoma examination and treatment in one million population of the 40–69 years age group in urban area in India is around 396 million. If an urban community screening programme for diagnosing and treating glaucoma for one million population of 40–69 years age group is implemented, the estimated total costs would be 670
Discussion
Our sensitivity analyses revealed that apart from glaucoma prevalence rates across various age groups, other factors such as screening uptake rates, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. Lower values of screening uptake rates showed higher ICER values pointing to the need for improving screening uptake rates for increased
Acknowledgements
The first author acknowledges the support of Dr. Toni Ashton, Professor, School of Population Health, University of Auckland, for critical comments for this manuscript.
Ethical approval
None sought.
Funding
No funding support was received to conduct this study. However, the authors acknowledge the support of NZAID Commonwealth Scholarship provided to the first author for conducting this exercise as part of his dissertation for MPH degree at University of Auckland, New Zealand.
Competing interests
None declared.
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