Background Glaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres.
Methods The analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded.
Results 1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273.
Conclusion Glaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.
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Contributors LTP served as the cost investigator for this study and oversaw all aspects of the cost study design, methods and analysis, as well as manuscript preparation, review and submission. MW served as the clinical investigator for the parent study and contributed clinical context to study design, methods development, and manuscript preparation and review. LH served as the research director for the parent study and contributed to study design, methods development, and manuscript preparation and review. HS served as the study coordinator for the parent study and contributed to manuscript preparation and review. PL served as a cost advisor for this analysis and contributed to manuscript review. JEC served as one of two expert collaborators at the US Centers for Disease Control and Prevention (CDC) and contributed to manuscript review. JBS served as one of two expert collaborators at the US Centers for Disease Control and Prevention (CDC) and contributed to manuscript review. DS served as the research assistant for the cost analysis and contributed to manuscript review. LJK was the primary clinical investigator of the parent study and contributed to study design, methods development and manuscript review.
Funding This work was funded by the US Centers for Disease Control and Prevention, grant #1U58DP004060-01. LJK reports grants from financial support: US Centers for Disease Control and Prevention (grant no 1U58DP004060).
Disclaimer The findings and conclusions in this paper are those of the authors and do not necessarily reflect the official position of the US Centers of Disease Control and Prevention.
Competing interests MW reports grants from US Centers for Disease Control and Prevention (CDC) during the conduct of the study; and reports grants from Iridex, Diopsys, Heidelberg Engineering, Allergan, OrCam, Merck, Partridge Foundation and Pennsylvania Department of Health, outside the submitted work. PL reports other funding from CDC outside of the submitted work. LJK reports grants from the CDC during the conduct of the study; and reports grants and personal fees from Allergan, from Aerie Pharmaceutical, Bausch & Lomb, InnFocus, Mati Therapeutics, and Diopsys, and personal fees from Alcon, Glaukos, Sucampo, Inotek, Sensimed AG, Alimera Sciences, ForSight Vision, Ocular Therapeutix, and Aerpio Therapeutics, outside the submitted work.
Patient consent No identifiable patient information is being presented, as all information is presented in aggregate only.
Ethics approval Wills Eye Hospital Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.