Research Department, Institut Català de la Retina (ICR).
Ophthalmology Service.
J Glaucoma. 2023 Feb 1;32(2):72-79. doi: 10.1097/IJG.0000000000002132. Epub 2022 Oct 3.
The manuscript evaluates cost-effectiveness of glaucoma screening with imaging devices and telemedicine based on a screening campaign performed in Spain. The screening strategy implemented in our analysis was cost-effective compared with opportunistic case finding.
Open angle glaucoma is an asymptomatic ocular disease that represents one of the first causes of blindness. Diagnosis is currently made by opportunistic case finding, usually by community optometrists or general ophthalmologists. The aim of this study was to assess the cost-effectiveness of a screening strategy based on optical coherence tomography and fundus photographs in glaucoma detection.
A cost-effectiveness analysis was carried out to compare 2 alternative strategies: opportunistic finding versus screening. A Markov tree model was carried out with 10 health states according to disease progression. Quality-adjusted life years (QALYs) were used as a measure of effectiveness. We included short-term and long-term direct health costs and a discount rate of 3%. We performed a probabilistic sensitivity analysis and several 1-way sensitivity analyses.
The cohort in the screening program entailed an increase in 0.097 QALYs and additional costs of €1187 versus opportunistic finding, with an incremental cost-effectiveness ratio of about €12.214/QALY. The 1-way sensitivity analysis showed that inputs related to age and screening program (cost and detection rate) were those most strongly influencing the results of the analysis. Probabilistic sensitivity analyses showed that the model was robust to significant changes in the main variables of the analysis.
The screening strategy implemented in our analysis was cost-effective compared with opportunistic finding in patients with glaucoma in this Spanish setting.
本文评估了基于西班牙筛查活动的成像设备和远程医疗进行青光眼筛查的成本效益。与机会性发现相比，我们分析中实施的筛查策略具有成本效益。
开角型青光眼是一种无症状的眼部疾病，是失明的首要原因之一。目前通过机会性发现进行诊断，通常由社区验光师或普通眼科医生进行。本研究旨在评估基于光学相干断层扫描和眼底照相的青光眼检测筛查策略的成本效益。
进行了成本效益分析，以比较两种替代策略：机会性发现与筛查。使用根据疾病进展的 10 种健康状态进行了马尔可夫树模型。质量调整生命年（QALYs）用作有效性的衡量标准。我们包括短期和长期直接健康成本和 3%的折扣率。我们进行了概率敏感性分析和几种单向敏感性分析。
筛查计划中的队列导致 QALYs 增加 0.097，与机会性发现相比额外增加了 1187 欧元的成本，增量成本效益比约为 12.214 欧元/QALY。单因素敏感性分析表明，与年龄和筛查计划（成本和检出率）相关的投入是对分析结果影响最大的因素。概率敏感性分析表明，该模型对分析主要变量的重大变化具有稳健性。
与西班牙该环境下的机会性发现相比，我们分析中实施的筛查策略在青光眼患者中具有成本效益。
