[Cost-effectiveness analysis of the screening strategies for primary angle closure glaucoma]

Abstract

Purpose: To evaluate varlous primary angle clouse glaucoma(PACG)screening strategies by cost effectiveness analysis for choosing the best screening strategy.

Methods: We designed a model of the process of PACG screening, diagnosis, treatment, and estimated variable parameters of this model through literatures reviewed and the results of our study. Then four screening strategiers which are oblique flashlight test, measurement of axial anterior chamber depth (AACD), examination of peripheral anterior chamber depth (PACD), and combination of oblique flashlight test with examination of PACD in series were calculated by computer to obtain the costs for various screening strategies and the quality ajusted life years (QALYs) saved. We performed sensitivity analysis to determine how the variation in the parameter assumptions would affect the calculated cost effectiveness of the various screening strategies. Based on the principle of cost effectiveness, the screening strategy of more cost effective would be chosen.

Results: The results showed that no matter what age group, the screening strategy of oblique flashlight test and measuring PACD combined in series is the lowest cost per QALY gained than other strategies. This screening strategy is optimum, next is oblique flashlight test Screening method. We found that screening strategies not only gains QALY, but also is cost saving as well in the range 40-< 70 years old. sensitivity analysis result showed that optimum strategy is still the combined serial strategy, in addition to the capable closure angle ratio of a population with a 10% up and down, the oblique flashlight test became an optimum strategy and the combined serial method became next in > or = 70 years old group.

Conclusion: The results showed that the oblique flashlight test and measurement of PACD combined in series is an optimum screening strategy. This research suggests that using adequate screening strategy should not only increase the QALYs, but also save the cost for the government and the patients themselves.