Cost effectiveness and cost utility of an organized screening programme for glaucoma
Article first published online: 25 JUL 2007
© 2007 The Authors
Acta Ophthalmologica Scandinavica
Volume 85, Issue 5, pages 508–518, August 2007
How to Cite
Vaahtoranta-Lehtonen, H., Tuulonen, A., Aronen, P., Sintonen, H., Suoranta, L., Kovanen, N., Linna, M., Läärä, E. and Malmivaara, A. (2007), Cost effectiveness and cost utility of an organized screening programme for glaucoma. Acta Ophthalmologica Scandinavica, 85: 508–518. doi: 10.1111/j.1600-0420.2007.00947.x
- Issue published online: 25 JUL 2007
- Article first published online: 25 JUL 2007
- Received on October 4th, 2006. Accepted on March 26th, 2007.
- Markov model;
- visual disability;
- willingness to pay
Purpose: To assess the cost effectiveness and cost utility of an organized screening programme for glaucoma. The previous cost-effectiveness studies of screening show inconsistent results, and the cost utility of screening has not been assessed.
Methods: An organized screening programme was simulated using Markov modelling in a population aged 50–79 years at 5 year intervals. The programme ended when the subjects reached the age of 80 years. The comparator was opportunistic case finding. The main outcome measures were cases and years of severe visual disability avoided, quality-adjusted life years (QALYs) gained and direct healthcare and non-healthcare costs.
Results: The incremental cost of 1 year of avoided visual disability by screening was €32 602. The cost of one QALY gained by screening was €9023 with a discount rate of 5%. During the average 20 year time horizon considered, the cumulative incremental costs of screening in a population of 1 million people would be €30 million, producing 3360 incremental QALYs and 930 years of avoided visual disability for 701 persons. The results were sensitive to the estimates of several parameters, especially screening cost and specificity of screening tests (96–99% specificity required).
Conclusion: An organized screening programme could be a cost-effective strategy especially in older age groups, in which screening is clearly more likely to be acceptable to decision makers at any level in terms of their willingness to pay for a QALY. Modelling includes some uncertainty especially concerning the specificity of diagnostic tests and screening cost.