July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Cost-effectiveness and cost-utility of population-based glaucoma screening in China: A decision-analytic Markov model
Author Affiliations & Notes
  • Nathan G Congdon
    Orbis/Queen's University Belfast, Belfast, Ireland
    Preventive Ophthalmology, Zhongshan Ophthalmic Center, Guangzhou, Guangdong, China
  • Jianjun Tang
    UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
    School of Agricultural Economics and Rural Development, Renmin University of China, Beijing, China
  • Yuanbo Liang
    Wenzhou Medical University, Wenzhou, China
  • Ciaran O'Neill
    UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
  • Frank Kee
    UKCRC Centre of Excellence for Public Health (NI), Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
  • Footnotes
    Commercial Relationships   Nathan Congdon, None; Jianjun Tang, None; Yuanbo Liang, None; Ciaran O'Neill, None; Frank Kee, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 1956. doi:https://doi.org/
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      Nathan G Congdon, Jianjun Tang, Yuanbo Liang, Ciaran O'Neill, Frank Kee; Cost-effectiveness and cost-utility of population-based glaucoma screening in China: A decision-analytic Markov model. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1956. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To assess the cost-effectiveness and cost-utility of population-level glaucoma screening in China. Such screening has not been found cost-effective in developed countries.

Methods : Separate and combined decision-analytic Markov models were developed for Primary Angle-Closure Glaucoma (PACG) and Primary Open-Angle Glaucoma (POAG), to evaluate costs and benefits of community-level screening versus opportunistic case finding from a societal perspective. Analyses were conducted separately for rural and urban settings. Screening costs were taken from an actual Chinese screening program, and treatment costs from a tertiary Chinese eye hospital. Main outcomes were quality-adjusted life-years (QALYs) and years of blindness avoided. One-way and probabilistic sensitivity analyses were conducted.

Results : As compared with no screening, combined screening of POAG and PACG in rural settings results in an incremental cost-utility ratio (ICUR) of $889 (95% CI, -$109 to $3,920) and an incremental cost-effectiveness ratio (ICER) of $1,770 (95% CI, -$192 to $7,210)], both of which are below the cost-effectiveness threshold of 1-3 times rural GDP. For the urban setting, combined screening results in less net costs and greater gain in health benefits than no screening ([ICUR: -$50 (95% CI, -$667 to $845); ICER: -$127 (95% CI, -$1,550 to $2,240)]. Findings were robust in all sensitivity analyses. A total of 291 (95% CI, 69 to 699) and 1,710 (95% CI, 611 to 3,408) years of blindness would be avoided for every 100,000 rural and urban residents screened, respectively.

Conclusions : Population screening for glaucoma (POAG and PACG combined) is highly cost-effective in both urban and rural China.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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