title: Cost-effectiveness and cost utility of community screening for glaucoma in urban India.
abstract: OBJECTIVE
  Population-based screening for glaucoma has been demonstrated to be cost-effective if targeted at high-risk groups such as older adults and those with a family history of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India.
  
  
  METHODS
  A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India.
  
  
  METHODS
  Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted.
  
  
  RESULTS
  The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme.
  
  
  CONCLUSIONS
  In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening programme for glaucoma for the 40-69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India.
authors.affiliation: Tutor-Health Economics, Peoples Open Access Education, Initiative (Peoples-uni), 34, Stafford Road, Eccles, Manchester, M30 9ED, United Kingdom. Electronic address: djohn1976@gmail.com.
authors.forename: Denny
authors.initials: D
authors.lastname: John
authors.affiliation: Consultant & Glaucoma Specialist, Shreeji Eye Clinic & Palak's, Glaucoma Care Center, Samrat Building, M Vasanji Road, Andheri (East), Mumbai, India. Electronic address: drparikhs@gmail.com.
authors.forename: Rajul
authors.initials: R
authors.lastname: Parikh
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005901:Glaucoma / Q000453:epidemiology / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D015397:Program Evaluation; D019037:Urban Health Services / Q000191:economics*; D015351:Vision Screening / Q000191:economics*
keywords: Angle-closure disease; Cost utility; Cost-effectiveness; India; Primary open-angle glaucoma; Urban