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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.
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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.
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.
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.
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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