Abstract
India has an estimated 12 million people affected with glaucoma; however, no organised screening programme exists. Cases are usually detected opportunistically. This study documents the protocol for detecting glaucoma in suspects in cataract camps conducted by Shroff Charity Eye Hospital in North India. We report a cost-effectiveness alongside prospective study design of patients attending cataract camps where glaucoma screening will be integrated. The eligible population for glaucoma screening is non-cataract patients. Patients will undergo glaucoma screening by a trained optometrist using a pre-determined glaucoma screening algorithm. Specific diagnostic cut-off points will be used to identify glaucoma suspects. Suspected patients will be referred to the main hospital for confirmatory diagnosis and treatment. This group will be compared to a cohort of patients arriving from cataract camps conducted by the institute in similar areas and undergoing examination in the hospital. The third arm of the study includes patients arriving directly to the hospital for the first time. Cost data will be captured from both the screening components of cataract-only and glaucoma screening-integrated camps for screening invitation and screening costs. For all three arms, examination and treatment costs will be captured using bottom-up costing methods at the hospital. Detection rates will be calculated by dividing the number of new cases identified during the study by total number of cases examined. Median, average and range of costs across the three arms will be calculated for cost comparisons. Finally, cost-effectiveness analysis will be conducted comparing cost per case detected across the three arms from a quasi-societal perspective with a time horizon of 1 year .Ethics approval for the study has been obtained from the institutional ethics committee of the hospital.The study protocol will be useful for researchers and practitioners for conducting similar economic evaluation studies in their context.
Highlights
The term ‘glaucoma’ was derived from the Greek word γλαύκωμα (Glaucosis) during the Hippocratic era of 400 BC, and it meant the greenish pupillary hue in eye that is much different from the normal pupillary color[1]
In angle-closure glaucoma (ACG), pupillary blockage leads to sudden rise of intraocular pressure (IOP) manifesting as severe headache, intense ocular pain, redness, clouding or haziness of cornea, and are further compounded with acute and marked diminution or even loss of vision within few hours, presenting as an emergency and warranting immediate therapeutic intervention to save vision
open-angle glaucoma (OAG) remains silent for several years till the slow and gradual rise in IOP leads to manifest optic nerve damage and peripheral visual fields changes, and can be diagnosed in ocular examination or linked with the family history
Summary
The term ‘glaucoma’ was derived from the Greek word γλαύκωμα (Glaucosis) during the Hippocratic era of 400 BC, and it meant the greenish pupillary hue in eye that is much different from the normal pupillary color[1]. OAG remains silent for several years till the slow and gradual rise in IOP leads to manifest optic nerve damage and peripheral visual fields changes, and can be diagnosed in ocular examination or linked with the family history. There are estimated 12 million people affected by glaucoma in India[3]. It is estimated that about 70% of OAG and 80% of ACG cases occur in developing nations[4]. In India it is estimated that primary OAG (POAG) affects around 6.48 million people and primary ACG (PACG) affects around 2.54 million[3]. In India, it is estimated that among the 40+ age group, every eighth person could be at risk of, or, suffering from glaucoma[3]. As there is no organised screening for glaucoma, opportunistic case finding is the commonest method for case detection. Stressing the need of a more effective screening program
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