title: Cost and detection rate of glaucoma screening with imaging devices in a primary care center.
abstract: OBJECTIVE
  To analyze the cost and detection rate of a screening program for detecting glaucoma with imaging devices.
  
  
  METHODS
  In this cross-sectional study, a glaucoma screening program was applied in a population-based sample randomly selected from a population of 23,527. Screening targeted the population at risk of glaucoma. Examinations included optic disk tomography (Heidelberg retina tomograph [HRT]), nerve fiber analysis, and tonometry. Subjects who met at least 2 of 3 endpoints (HRT outside normal limits, nerve fiber index ≥30, or tonometry ≥21 mmHg) were referred for glaucoma consultation. The currently established ("conventional") detection method was evaluated by recording data from primary care and ophthalmic consultations in the same population. The direct costs of screening and conventional detection were calculated by adding the unit costs generated during the diagnostic process. The detection rate of new glaucoma cases was assessed.
  
  
  RESULTS
  The screening program evaluated 414 subjects; 32 cases were referred for glaucoma consultation, 7 had glaucoma, and 10 had probable glaucoma. The current detection method assessed 677 glaucoma suspects in the population, of whom 29 were diagnosed with glaucoma or probable glaucoma. Glaucoma screening and the conventional detection method had detection rates of 4.1% and 3.1%, respectively, and the cost per case detected was 1,410 and 1,435€, respectively. The cost of screening 1 million inhabitants would be 5.1 million euros and would allow the detection of 4,715 new cases.
  
  
  CONCLUSIONS
  The proposed screening method directed at population at risk allows a detection rate of 4.1% and a cost of 1,410 per case detected.
authors.affiliation: Medicine School, Universidad Internacional de Cataluña; Servei d'Estudies, Parc de Salut Mar; Instituto Hospital del Mar de Investigaciones Médicas (IMIM); Glaucoma Department, Instituto Catalán de Retina (ICR).
authors.forename: Alfonso
authors.initials: A
authors.lastname: Anton
authors.affiliation: Instituto Hospital del Mar de Investigaciones Médicas (IMIM); Universidad Autónoma de Barcelona.
authors.forename: Monica
authors.initials: M
authors.lastname: Fallon
authors.affiliation: Servei d'Estudies, Parc de Salut Mar.
authors.forename: Francesc
authors.initials: F
authors.lastname: Cots
authors.affiliation: Centro de Atención Primaria Larrard, Barcelona, Spain.
authors.forename: María A
authors.initials: MA
authors.lastname: Sebastian
authors.affiliation: Glaucoma Department, Instituto Catalán de Retina (ICR).
authors.forename: Antonio
authors.initials: A
authors.lastname: Morilla-Grasa
authors.affiliation: Instituto Hospital del Mar de Investigaciones Médicas (IMIM).
authors.forename: Sergi
authors.initials: S
authors.lastname: Mojal
authors.affiliation: Servei d'Estudies, Parc de Salut Mar.
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
keywords: cost; detection rate; glaucoma; imaging devices; screening