Tutor-Health Economics, Peoples Open Access Education, Initiative (Peoples-uni), 34, Stafford Road, Eccles, Manchester, M30 9ED, United Kingdom.
Consultant & Glaucoma Specialist, Shreeji Eye Clinic & Palak's, Glaucoma Care Center, Samrat Building, M Vasanji Road, Andheri (East), Mumbai, India.
Public Health. 2017 Jul;148:37-48. doi: 10.1016/j.puhe.2017.02.016. Epub 2017 Apr 6.
Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India.
A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India.
Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted.
The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, 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.
In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.
如果以老年人和有青光眼家族史等高危人群为目标，并使用技术员进行初步评估而不是由医学专家进行，基于人群的青光眼筛查已被证明具有成本效益。本研究试图调查在印度城市地区，与现行实践（即没有筛查计划，但有一些机会性病例发现）相比，对青光眼进行假设的社区筛查和后续治疗计划的成本效益。
为印度城市地区 40 至 69 岁人群建立了一种针对原发性开角型青光眼和闭角型青光眼的假设性筛查计划。
从印度一家三级眼科医院的管理人员处获得筛查和治疗成本。筛查途径的概率来自已发表的文献和专家意见。城市地区的青光眼患病率数据改编自钦奈青光眼研究的结果。使用 TreeAge Pro 2015 构建了一个决策分析模型，以模拟事件、成本和治疗途径。进行了单因素敏感性分析。
引入社区青光眼筛查计划可能具有成本效益，与没有筛查计划相比，估计的增量成本效益比（ICER）值为 10668.68，在印度城市地区，将在 10 年内额外治疗 4443 例病例，并预防 1790 人年的失明。敏感性分析表明，各年龄段的青光眼患病率、筛查参与率、筛查后的随访依从性、治疗成本以及与青光眼医疗和手术治疗相关的健康状态的效用值均对筛查计划的 ICER 值产生影响。
与现行实践（即没有筛查计划，但有一些机会性病例发现）相比，如果在印度城市地区实施，针对 40-69 岁人群的社区青光眼筛查计划可能具有相对成本效益。
