Cost-Effectiveness of Screening for Open Angle Glaucoma With Confocal Scanning Laser Ophthalmoscopy (hrt3) in Glaucoma High-Risk Populations

Abstract

Purpose: : To assess the cost-effectiveness of screening for open-angle glaucoma (OAG) with confocal scanning laser ophthalmoscopy (HRT3) in high-risk populations (All subjects older than 65 years of age, subjects older than 50 years of Caribbean or African descent, or with positive family history for open-angle glaucoma).

Methods: : A decision analysis model was created to compare screening of high risk subjects using HRT3 to screening using visual field tests (Frequency Doubling Technology perimeter (FDT)). Data input of cost and effectiveness of the devices were extracted from the Mobile Glaucoma Screening Project (MGSP) in high risk populations and the Régie de l’assurance maladie du Québec (RAMQ). We simulated one screening session using both FDT and HRT3 in a population composed of 10,000 high risk subjects. The incremental cost-effectiveness ratio (ICER) of HRT3 was evaluated using the TreeAge Pro software. The model determined the additional cost per new case of glaucoma diagnosed.

Results: : Our cost-effectiveness model demonstrated that the cost for using HRT3 as screening tool was estimated at $CA 507,833, and detected a total of 763 cases per 10,000 screened subjects (C/E ratio of $CA 665 per case detected). Compared to the use of visual fields (FDT) for screening purpose, the HRT3 had an ICER of $CA 239 per new case of glaucoma detected (incremental cost of $CA 36,439 for 152 additional cases detected).

Conclusions: : Screening with HRT3 would imply additional costs compared to FDT. Whether this additional expenditure in compensated by the cost of missing one case would be determined in further studies.

Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • detection • imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound)