Cost effectiveness and cost utility of an organized screening programme for glaucoma


Anja Tuulonen
Department of Ophthalmology
University of Oulu
PO Box 5000
FI-90014 Oulu
Tel: + 358 8315 3299
Fax: + 358 8330 122


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.