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Editors Selection IGR 9-2

Cost Economics: Cost-effectiveness of screening

Comment by Esther Hoffmann on:

26601 Health-economic aspects of glaucoma screening, Hirneiss C; Niedermaier A; Kernt M et al., Ophthalmologe, 2010; 107: 143-149

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This article by Hirneiss et al. (1472) is based on a database search (CDSR, HTA, MEDLINE, EMBASE), yielding for glaucoma screening and its cost-effectiveness and for cost-utility estimation. The costs for glaucoma screening have not been accepted by health insurances due to a missing standard in diagnosing glaucoma (often there is no 'yes' or 'no'), due to concerns about glaucoma diagnosis based on tono metry, due to concerns about high false positive rates when using modern diagnostic instruments leading to unneeded treatment, and due to the low prevalence of glaucoma in the population. Although several instruments are available for detection of glaucoma, no single screening instrument has been shown to perfectly discriminate subjects with and without glaucoma. Furthermore, diagnostic studies of glaucoma lack a generally approved definition of the disease.

At the moment there is no evidence for whether glaucoma screening is cost-effective or not

The estimates of sensitivity and specificity show large variability and are far lower than the requirements for a screening dominance (less costly and more At the moment there is no evidence for whether glaucoma screening is cost-effective or not effective). The problems of current evidence in relation to economic modelling are highlighted in a Finnish and a Scottish study mentioned by the authors. The results of the two studies fully agreed in the major aspects: At the moment there is no evidence for whether glaucoma screening is cost-effective or not. Both studies, however, encourage further research in order to evaluate subgroups possibly eligible for screening. A randomised screening trial would give reliable evidence for the cost-effectiveness of glaucoma screening for preventing glaucoma induced visual disability and blindness.

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