John D, Parikh R
Campbell Collaboration, New Delhi, India; Department of Health Services Research, CAPHRI Care & Public Health Research Institute, Maastricht University, The Netherlands.
Shreeji Eye Clinic & Palak's Glaucoma Care Center, Samrat Building, M Vasanji Road, Andheri (East), Mumbai, India.
Public Health. 2018 Feb;155:142-151. doi: 10.1016/j.puhe.2017.11.004. Epub 2018 Feb 2.
Studies in several countries have demonstrated the cost-effectiveness of population-based screening for glaucoma when targeted at high-risk groups such as older adults and with familial history of disease. This study conducts a cost-effective analysis of a hypothetical community screening and subsequent treatment programme in comparison to opportunistic case finding for glaucoma in rural 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 rural areas of India.
A decision analytical model was built to model events, costs and treatment pathways with and without a hypothetical screening programme for glaucoma for a rural-based population aged between 40 and 69 years in India. The treatment pathway included both primary open-angle glaucoma and angle-closure disease. The data on costs of screening and treatment were provided by an administrator of a tertiary eye hospital in Eastern India. The probabilities for the screening and treatment pathway were derived from published literature and a glaucoma specialist. The glaucoma prevalence rates were adapted from the Chennai Glaucoma Study findings.
An incremental cost-effectiveness ratio value of ₹7292.30 per quality-adjusted life-year was calculated for a community-screening programme for glaucoma in rural India. The community screening for glaucoma would treat an additional 2872 cases and prevent 2190 person-years of blindness over a 10-year period.
Community screening for glaucoma in rural India appears to be cost-effective when judged by a ratio of willingness-to-pay thresholds as per WHO-CHOICE guidelines. For community screening to be cost-effective, adequate resources, such as trained medical personnel and equipment would need to be made available.
多个国家的研究表明，针对老年人和有家族病史等高危人群开展基于人群的青光眼筛查具有成本效益。本研究对印度农村地区假设的社区筛查及后续治疗方案与青光眼机会性病例发现进行了成本效益分析。
为印度农村地区40至69岁人群构建了一个针对原发性开角型青光眼和闭角型青光眼的假设筛查方案。
建立了一个决策分析模型，以模拟印度农村地区40至69岁人群有无假设青光眼筛查方案情况下的事件、成本和治疗路径。治疗路径包括原发性开角型青光眼和闭角型青光眼。筛查和治疗成本数据由印度东部一家三级眼科医院的管理人员提供。筛查和治疗路径的概率来自已发表的文献和一位青光眼专家。青光眼患病率根据钦奈青光眼研究结果进行调整。
计算得出印度农村地区青光眼社区筛查方案的增量成本效益比为每质量调整生命年7292.30卢比。青光眼社区筛查在10年内将多治疗2872例病例，并预防2190人年的失明。
根据世界卫生组织-CHOICE指南的支付意愿阈值比例判断，印度农村地区青光眼社区筛查似乎具有成本效益。要使社区筛查具有成本效益，需要提供足够的资源，如训练有素的医务人员和设备。
