Abstract
Purpose :
Glaucoma is a leading cause of blindness worldwide and its screening in general populations has been proven to be no economic benefits due to low prevalence and high false-positive rate in whole population. Glaucoma susceptibility increased in highly myopic eyes. Thus, it is assumed that glaucoma screening in high myopia participants, which is a high-risk population, might be more efficient. Our study aims to assess and compare the economic benefit of high myopia population screening of glaucoma, with glaucoma screening in whole population.
Methods :
We developed Markov decision models for whole population and high myopia population glaucoma screening to evaluate costs and utilities of community-level screening versus opportunistic case (no screening) finding from a societal perspective. A cohort of individuals was followed in the model from age 20 years through a total of 80 1-year Markov cycles (lifelong). We did a meta-analysis of glaucoma prevalence studies based on previous studies and unpublished data to obtain prevalence for glaucoma. Screening costs were collected from community hospitals and treatment costs were collected from a tertiary Chinese hospital. Main outcomes were incremental cost-utility ratios (ICURs) using quality-adjusted life-years (QALYs). We did one-way deterministic sensitivity analysis to reflect uncertainty around ICRUs.
Results :
Compared to no screening, high myopia population screening of glaucoma in China is predicted to result in an ICUR of US$785 (95%CI 527 to 1,042), which is below the willing-to-pay (WTP) threshold of one to three times gross domestic product (GDP). Whole population screening of glaucoma in China is predicted to result in an ICUR of US$12,527 (95% CI 12,348 to 12,827) than no screening, which is at the boundary value of WTP threshold. Findings were robust in all sensitivity analyses.
Conclusions :
High myopia population glaucoma screening is a cost-effectiveness method comparing to whole population screening. High risk population screening might be a potential strategy of glaucoma screening. Further analysis might focus on the rural-urban differences in order to explore the feasibility of national promotion.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.