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Kennedy K, Sarohia G, Podbielski D, Pickard S, Tarride JE, Xie F. Systematic methodological review of health state values in glaucoma cost-utility analyses. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01663-x. [PMID: 38411844 DOI: 10.1007/s10198-023-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/21/2023] [Indexed: 02/28/2024]
Abstract
IMPORTANCE Describing the characteristics and sources of health state utility values and reporting practice in the literature of cost-utility analyses facilitates an understanding of the level of the transparency, validity, and generalizability of cost-utility analyses. Improving the quality of reporting will support investigators in describing the incremental value of emerging glaucoma interventions. OBJECTIVE To describe the state of practice among published glaucoma cost-utility analysis studies, focusing on valuation of health and the quality of reporting. EVIDENCE REVIEW We searched several databases including Medline, CINHAL, Embase, Web of Science, Scopus, Biosis previews, the Health Economic Evaluations Database, and the NHS Economic Evaluation Database (NHS EED). We included full-text, English, published cost-utility analyses of glaucoma interventions with quality-adjusted life years (QALYs) as the primary outcome measure to calculate incremental cost-utility ratios. Excluded studies were non-English language, reviews, editorials, protocols, or other types of economic studies (cost-benefit, cost-minimization, cost-effectiveness). Study characteristics, operational definitions of glaucoma health states and health state utilities were extracted. The original source of the health utility was reviewed to determine the scale of measurement and the source of preference weighting. Items from the Systematic Review of Utilities for Cost-Effectiveness (SpRUCE checklist) were used to assess the reporting and quality of health utilities in glaucoma CUA. FINDINGS 43 CUAs were included, with 11 unique sources of health utilities. A wide range of health utilities for the same Hodapp-Parrish-Anderson glaucoma health states were reported; ocular hypertension (0.84-0.95), mild (0.68-0.94), moderate (0.57-0.92), advanced (0.58-0.88), severe/blind (0.46-0.76), and bilateral blindness (0.26-0.5). Most studies reported the basis for using health utilities (34, 79%) and any assumptions or adjustments applied to the health utilities (22, 51%). Few studies reported a framework for assessing the relevance of health utilities to a decision context (8, 19%). Even fewer (3, 7%) applied a systematic search strategy to identify health utilities and used a structured assessment of quality for inclusion. Overall, reporting has not improved over time. CONCLUSIONS AND RELEVANCE This review describes that few CUAs describe important rationale for using health state utility values. Including additional details on the search, appraisal, selection, and inclusion process of health utility values improves transparency, generalizability and supports the assessment of the validity of study conclusions. Future investigations should aim to use health utilities on the same scale of measurement across health states and consider the source and relevance to the decision context/purpose of conducting that cost-utility study.
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Affiliation(s)
- Kevin Kennedy
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Gurkaran Sarohia
- Department of Ophthalmology and Visual Sciences, University of Alberta, 400, 10924, 107 Avenue, Edmonton, AB, T5H 0X5, Canada
| | | | - Simon Pickard
- College of Pharmacy-Pharmacy Systems Outcomes and Policy, University of Illinois Chicago, Chicago, USA
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
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Olawoye OO, Ha TH, Pham N, Nguyen L, Cherwek DH, Fowobaje KR, Ross C, Coote M, Chan VF, Kahook M, Peto T, Azuara-Blanco A, Congdon N. Impact of a short online course on the accuracy of non-ophthalmic diabetic retinopathy graders in recognising glaucomatous optic nerves in Vietnam. BMJ Open 2023; 13:e076623. [PMID: 37945295 PMCID: PMC10649381 DOI: 10.1136/bmjopen-2023-076623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/12/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam. METHODS This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one-to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed. RESULTS Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders' mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p<0.001), and post-training score did not differ from ophthalmologists (58.7±15.4%, p=0.384). Although grader sensitivity reduced before [85.5% (95% CI 83.5% to 87.3%)] versus after [80.4% (78.3% to 82.4%)] training, specificity improved significantly [47.8 (44.9 to 50.7) vs 79.8 (77.3 to 82.0), p<0.001]. Grader AUC also improved after training [66.6 (64.9 to 68.3)] to [80.1 (78.5 to 81.6), p<0.001]. Additional one-to-one grader training by a glaucoma specialist did not further improve grader scores. CONCLUSION Non-ophthalmic DR graders can be trained to recognise glaucoma using a short online course in this setting, with no additional benefit from more expensive one-to-one training. After 5-hour online training in recognising glaucomatous optic nerve head, scores of non-ophthalmic DR graders doubled, and did not differ from local ophthalmologists. Intensive one-to-one training did not further improve performance.
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Affiliation(s)
- Olusola Oluyinka Olawoye
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Ngoc Pham
- ORBIS International, New York, New York, USA
| | - Lam Nguyen
- Hanoi Medical University, Hanoi, Viet Nam
| | | | | | - Craig Ross
- Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Michael Coote
- Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Ving Fai Chan
- School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK
| | - Malik Kahook
- University of Colorado at Colorado Springs, Colorado, UK
| | - Tunde Peto
- Faculty of Medicine Health and Life Sciences, Queen's University Belfast, Belfast, Belfast, UK
| | | | - Nathan Congdon
- Department of Ophthalmology and Public Health, Queen's University Belfast, Belfast, UK
- Orbis International NY USA, New York, New York, USA
- Department of Ophthalmology, Zhongshan Ophthalmic Centre, Guangzhou, People's Republic of China
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Richardson QR, Kumar RS, Ramgopal B, Rackenchath MV, A V SD, Mannil SS, Nagaraj S, Moe CA, Wittberg DM, O'Brien KS, Oatts JT, Stamper RL, Keenan JD. Diagnostic accuracy of an iPad application for detection of visual field defects. Eye (Lond) 2023; 37:1690-1695. [PMID: 36064770 PMCID: PMC10220016 DOI: 10.1038/s41433-022-02223-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/27/2022] [Accepted: 08/22/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Tablet-based perimetry could be used to test for glaucomatous visual field defects in settings without easy access to perimeters, although few studies have assessed diagnostic accuracy of tablet-based tests. The goal of this study was to determine the diagnostic accuracy of iPad perimetry using the visualFields Easy application. SUBJECTS/METHODS This was a prospective, cross-sectional study of patients undergoing their first Humphrey Field Analyser (HFA) visual field test at a glaucoma clinic in India. Participants underwent 24-2 SITA Standard HFA testing and iPad-based perimetry with the visualFields Easy application. Reference standards for both visual field loss and suspected glaucoma were determined by ophthalmologist review of HFA results and optic disc photographs. Receiver operating characteristic curves were constructed to assess diagnostic accuracy at various test thresholds. RESULTS 203 eyes from 115 participants were included, with 82 eyes classified as moderate or worse glaucoma. iPad perimetry had an area under the receiver operating characteristic (AUROC) curve of 0.64 (95% CI 0.57 to 0.71) for detection of any visual field defect relative to HFA and an AUROC of 0.68 (0.59 to 0.76) for detection of moderate or worse glaucoma relative to ophthalmologist examination. At a set specificity of 90%, the sensitivity of iPad perimetry for detection of moderate or worse glaucoma was 35% (22-48%). CONCLUSIONS iPad perimetry using the visualFields Easy application had inadequate diagnostic accuracy to be used as a screening tool for glaucoma in this South Indian population.
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Affiliation(s)
| | - Rajesh S Kumar
- Narayana Nethralaya Eye Hospital, Bangalore, India
- Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - B Ramgopal
- Narayana Nethralaya Eye Hospital, Bangalore, India
| | | | | | - Suria S Mannil
- Narayana Nethralaya Eye Hospital, Bangalore, India
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Caitlin A Moe
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Dionna M Wittberg
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Kieran S O'Brien
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Julius T Oatts
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Robert L Stamper
- Department of Ophthalmology, University of California, San Francisco, CA, USA
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA.
- Department of Ophthalmology, University of California, San Francisco, CA, USA.
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Lemij HG, de Vente C, Sánchez CI, Vermeer KA. Characteristics of a large, labeled dataset for the training of artificial intelligence for glaucoma screening with fundus photographs. OPHTHALMOLOGY SCIENCE 2023; 3:100300. [PMID: 37113471 PMCID: PMC10127130 DOI: 10.1016/j.xops.2023.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/12/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
Purpose Significant visual impairment due to glaucoma is largely caused by the disease being detected too late. Objective To build a labeled data set for training artificial intelligence (AI) algorithms for glaucoma screening by fundus photography, to assess the accuracy of the graders, and to characterize the features of all eyes with referable glaucoma (RG). Design Cross-sectional study. Subjects Color fundus photographs (CFPs) of 113 893 eyes of 60 357 individuals were obtained from EyePACS, California, United States, from a population screening program for diabetic retinopathy. Methods Carefully selected graders (ophthalmologists and optometrists) graded the images. To qualify, they had to pass the European Optic Disc Assessment Trial optic disc assessment with ≥ 85% accuracy and 92% specificity. Of 90 candidates, 30 passed. Each image of the EyePACS set was then scored by varying random pairs of graders as "RG," "no referable glaucoma (NRG)," or "ungradable (UG)." In case of disagreement, a glaucoma specialist made the final grading. Referable glaucoma was scored if visual field damage was expected. In case of RG, graders were instructed to mark up to 10 relevant glaucomatous features. Main Outcome Measures Qualitative features in eyes with RG. Results The performance of each grader was monitored; if the sensitivity and specificity dropped below 80% and 95%, respectively (the final grade served as reference), they exited the study and their gradings were redone by other graders. In all, 20 graders qualified; their mean sensitivity and specificity (standard deviation [SD]) were 85.6% (5.7) and 96.1% (2.8), respectively. The 2 graders agreed in 92.45% of the images (Gwet's AC2, expressing the inter-rater reliability, was 0.917). Of all gradings, the sensitivity and specificity (95% confidence interval) were 86.0 (85.2-86.7)% and 96.4 (96.3-96.5)%, respectively. Of all gradable eyes (n = 111 183; 97.62%) the prevalence of RG was 4.38%. The most common features of RG were the appearance of the neuroretinal rim (NRR) inferiorly and superiorly. Conclusions A large data set of CFPs was put together of sufficient quality to develop AI screening solutions for glaucoma. The most common features of RG were the appearance of the NRR inferiorly and superiorly. Disc hemorrhages were a rare feature of RG. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Ramachandran R, Joiner DB, Patel V, Popplewell D, Misra P, Kaplan CM, Hood DC, Al-Aswad LA. Comparison between the Recommendations of Glaucoma Specialists and OCT Report Specialists for Further Ophthalmic Evaluation in a Community-Based Screening Study. Ophthalmol Glaucoma 2022; 5:602-613. [PMID: 35688330 DOI: 10.1016/j.ogla.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/12/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To compare glaucoma referral patterns between glaucoma and OCT report specialists and to determine what influence, if any, a designated OCT reading could have on a glaucoma specialist's judgments. DESIGN Retrospective, exploratory study. SUBJECTS We included 483 eyes (243 individuals) from high-risk New York City neighborhoods screened as part of a mobile van glaucoma screening study from July 2017 to October 2017. METHODS All participants underwent comprehensive testing, including visual acuity, commercial OCT imaging, gonioscopy, intraocular pressure, frequency-doubling testing, and funduscopic assessment. Three glaucoma specialists independently evaluated all the collected data to determine whether a further glaucoma workup referral was recommended. Two OCT report specialists evaluated only the OCT image for each eye using the commercial report as well as a specialized, customized report. In phase II, the glaucoma specialists then re-evaluated a subset of these eyes, this time with an OCT report specialist's judgments made available. MAIN OUTCOME MEASURES Comparison of glaucoma specialist referrals made by glaucoma specialists versus OCT report specialists. RESULTS Intergrader agreement between glaucoma specialists was 60% (κ = 0.43) and between report specialists was 95% (κ = 0.77). There was an agreement between a single OCT report specialist and the consensus (2 of 3) of glaucoma specialists in 74% of eyes (κ= 0.32). Of the eyes studied, 25% were referred for further glaucoma evaluation by the glaucoma specialists alone and 1% were referred for further glaucoma workup by only the report specialist. With the addition of the report specialist's judgments, referral pattern changes varied by glaucoma specialist but overall agreement increased to 85% (κ = 0.53). CONCLUSIONS There was a fair level of agreement regarding glaucoma referral recommendations between glaucoma specialists with access to comprehensive screening data and OCT report specialists with access to only OCT data. Overall agreement increased when the designated OCT evaluation was made available to the glaucoma specialists. These results may aid in the design of future large-scale glaucoma screening studies.
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Affiliation(s)
| | - Devon B Joiner
- Department of Psychology, Columbia University, New York, New York
| | - Vipul Patel
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | | | - Poonam Misra
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Chad M Kaplan
- Department of Ophthalmology, NYU Langone Health, New York, New York
| | - Donald C Hood
- Department of Psychology, Columbia University, New York, New York; Department of Ophthalmology, Columbia University, New York, New York
| | - Lama A Al-Aswad
- Department of Ophthalmology, NYU Langone Health, New York, New York; Department of Ophthalmology, Columbia University, New York, New York.
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6
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Bhartiya S. Glaucoma Screening: Is AI the Answer? J Curr Glaucoma Pract 2022; 16:71-73. [PMID: 36128081 PMCID: PMC9452706 DOI: 10.5005/jp-journals-10078-1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Shibal Bhartiya
- Department of Ophthalmology, Glaucoma Services, Fortis Memorial Research Institute, Gurugram, Haryana, India
- Shibal Bhartiya, Department of Ophthalmology, Glaucoma Services, Fortis Memorial Research Institute, Gurugram, Haryana, India, e-mail:
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Fukai K, Terauchi R, Noro T, Ogawa S, Watanabe T, Nakagawa T, Honda T, Watanabe Y, Furuya Y, Hayashi T, Tatemichi M, Nakano T. Real-Time Risk Score for Glaucoma Mass Screening by Spectral Domain Optical Coherence Tomography: Development and Validation. Transl Vis Sci Technol 2022; 11:8. [PMID: 35938880 PMCID: PMC9366724 DOI: 10.1167/tvst.11.8.8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose To develop and validate a risk score assessable in real-time using only retinal thickness-related values measured by spectral domain optical coherence tomography alone for use in population-based glaucoma mass screenings. Methods A total of 7572 participants (aged 35-74 years) underwent spectral domain optical coherence tomography examination annually between 2016 to 2021 in a population-based setting. We selected 284 glaucoma cases and 284 controls, matched by age and sex, from 11,487 scans in 2016. We conducted multivariable logistic regression with backward stepwise selection of retinal thickness-related variables to develop the diagnostic models. The developed risk scores were applied to all participants in 2018 (9720 eyes), and we randomly selected 723 scans for validation. Additional validation using the Humphrey field analyzer was conducted on 129 eyes in 2020. We assessed the models using sensitivity, specificity, the area under the receiver operating characteristic curve and positive and negative predictive values. Results The best-predicting model achieved an area under the receiver operating characteristic curve of 0.97 (95% confidence interval, 0.96-0.98) with a sensitivity of 0.93 and specificity of 0.91. The validation dataset showed a positive predictive value of 90.8% for high-risk scorers, corresponding to 6.2% of the population, and negative predictive value of 88.2% for low-risk scorers, corresponding to 85.2%. Sensitivity and specificity for glaucoma diagnosis were 0.85 and 0.91, when we set the risk score cut-off at 90 points out of 100. Conclusions This risk score could be used as a valid index for glaucoma screening in a population-based setting. Translational Relevance The score is feasible by installing a simple computer application on an existing spectral domain optical coherence tomography and will help to improve the accuracy and efficiency of glaucoma screening.
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Affiliation(s)
- Kota Fukai
- Department of Preventive Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Ryo Terauchi
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiko Noro
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shumpei Ogawa
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | - Tomoyuki Watanabe
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Toru Honda
- Hitachi Health Care Center, Ibaraki, Japan
| | | | - Yuko Furuya
- Department of Preventive Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Masayuki Tatemichi
- Department of Preventive Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tadashi Nakano
- Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan
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8
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Khurana T, Gupta A, Rathi H. The state of cost-utility analysis in India: A systematic review. Perspect Clin Res 2021; 12:179-183. [PMID: 34760643 PMCID: PMC8525785 DOI: 10.4103/picr.picr_256_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: Cost-utility studies are crucial tools that help policy-makers promote appropriate resource allocation. The objective of this study was to evaluate the extent and quality of cost-utility analysis (CUA) in India through a systematic literature review. Methods: Comprehensive database search was conducted to identify the relevant literature published from November 2009 to November 2019. Gray literature and hand searches were also performed. Two researchers independently reviewed and assessed study quality using Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Thirty-five studies were included in the final review. Thirteen studies used Markov model, five used decision tree model, four used a combination of decision tree and Markov model and one each used microsimulation and dynamic compartmental model. The primary therapeutic areas targeted in CUA were infectious diseases (n = 12), ophthalmology (n = 5), and endocrine disorders (n = 4). Five studies were carried out in Tamil Nadu, four in Goa, three in Punjab, two each in Delhi, Maharashtra, and Uttar Pradesh, and one each in West Bengal and Karnataka. Twenty-three, eight, and four studies were found to be of excellent, very good, and good quality, respectively. The average quality score of the studies was 19.21 out of 24. Conclusions: This systematic literature review identified the published CUA studies in India. The overall quality of the included studies was good; however, features such as subgroup analyses and explicit study perspective were missing in several evaluations.
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Affiliation(s)
- Tanu Khurana
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Amit Gupta
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Hemant Rathi
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India.,Health Economics and Outcomes Research, Skyward Analytics Pte. Limited Singapore, Singapore
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9
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Olawoye O, Azuara-Blanco A, Chan VF, Piyasena P, Crealey GE, O'Neill C, Congdon N. A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa. Ophthalmic Epidemiol 2021; 29:328-338. [PMID: 34372742 DOI: 10.1080/09286586.2021.1939887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To populate a proposed cost-effectiveness analysis of glaucoma screening in Sub-Saharan Africa (SSA).A complete search was conducted on PubMed, Medline and African Journals Online (AJOL) to obtain relevant published articles, which were included in this review. All relevant articles on prevalence of glaucoma in SSA and among other African-derived populations, severity of glaucoma, cost of diagnosis and management, clinical effectiveness of glaucoma screening and treatment and the different glaucoma screening strategies in SSA were reviewed.Population screening interventions for glaucoma may be considered as follows: standalone screening for glaucoma, screening for glaucoma during cataract outreach, and screening incorporated with diabetic retinopathy image review using tele-ophthalmology. Our review suggests that cost of glaucoma treatment is relatively low with cost of medical treatment ranging from USD 273 to USD 480 per year/patient and surgical treatment cost of USD 283 per patient as with other developing countries. Compliance with medication is moderate to good in about 50% of glaucoma patients. Prevalence of glaucoma is much higher in SSA and almost 50% of glaucoma patients are blind in at least one eye at presentation in clinics (without outreach screening). Our review suggests a moderate sensitivity and specificity in identifying glaucoma with basic equipment (direct ophthalmoscope, contact tonometer and frequency doubling technology) during outreach screening although about a third or fewer take up glaucoma services in clinics.Our review provides the necessary information to conduct a cost-effective analysis of glaucoma screening in SSA using the decision Markov model.
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Affiliation(s)
- Olusola Olawoye
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,School of Optometry, College of Health Sciences, University of Kwa-Zulu Natal (Ving Fai Chan)
| | - Augusto Azuara-Blanco
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Ving Fai Chan
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,College of Health Sciences, University of Kwa-Zulu Natal, South Africa
| | - Prabhath Piyasena
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Grainne E Crealey
- J.E. Cairns School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK
| | - Nathan Congdon
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences. Queens, University Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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10
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Saeed AQ, Sheikh Abdullah SNH, Che-Hamzah J, Abdul Ghani AT. Accuracy of Using Generative Adversarial Networks for Glaucoma Detection During the COVID-19 Pandemic: A Systematic Review and Bibliometric Analysis. J Med Internet Res 2021; 23:e27414. [PMID: 34236992 PMCID: PMC8493455 DOI: 10.2196/27414] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 01/19/2023] Open
Abstract
Background Glaucoma leads to irreversible blindness. Globally, it is the second most common retinal disease that leads to blindness, slightly less common than cataracts. Therefore, there is a great need to avoid the silent growth of this disease using recently developed generative adversarial networks (GANs). Objective This paper aims to introduce a GAN technology for the diagnosis of eye disorders, particularly glaucoma. This paper illustrates deep adversarial learning as a potential diagnostic tool and the challenges involved in its implementation. This study describes and analyzes many of the pitfalls and problems that researchers will need to overcome to implement this kind of technology. Methods To organize this review comprehensively, articles and reviews were collected using the following keywords: (“Glaucoma,” “optic disc,” “blood vessels”) and (“receptive field,” “loss function,” “GAN,” “Generative Adversarial Network,” “Deep learning,” “CNN,” “convolutional neural network” OR encoder). The records were identified from 5 highly reputed databases: IEEE Xplore, Web of Science, Scopus, ScienceDirect, and PubMed. These libraries broadly cover the technical and medical literature. Publications within the last 5 years, specifically 2015-2020, were included because the target GAN technique was invented only in 2014 and the publishing date of the collected papers was not earlier than 2016. Duplicate records were removed, and irrelevant titles and abstracts were excluded. In addition, we excluded papers that used optical coherence tomography and visual field images, except for those with 2D images. A large-scale systematic analysis was performed, and then a summarized taxonomy was generated. Furthermore, the results of the collected articles were summarized and a visual representation of the results was presented on a T-shaped matrix diagram. This study was conducted between March 2020 and November 2020. Results We found 59 articles after conducting a comprehensive survey of the literature. Among the 59 articles, 30 present actual attempts to synthesize images and provide accurate segmentation/classification using single/multiple landmarks or share certain experiences. The other 29 articles discuss the recent advances in GANs, do practical experiments, and contain analytical studies of retinal disease. Conclusions Recent deep learning techniques, namely GANs, have shown encouraging performance in retinal disease detection. Although this methodology involves an extensive computing budget and optimization process, it saturates the greedy nature of deep learning techniques by synthesizing images and solves major medical issues. This paper contributes to this research field by offering a thorough analysis of existing works, highlighting current limitations, and suggesting alternatives to support other researchers and participants in further improving and strengthening future work. Finally, new directions for this research have been identified.
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Affiliation(s)
- Ali Q Saeed
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY.,Computer Center, Northern Technical University, Ninevah, IQ
| | - Siti Norul Huda Sheikh Abdullah
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY
| | - Jemaima Che-Hamzah
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Cheras, Kuala Lumpur, MY
| | - Ahmad Tarmizi Abdul Ghani
- Faculty of Information Science & Technology (FTSM), Universiti Kebangsaan Malaysia (UKM), UKM, 43600 Bangi, Selangor, Malaysia, Selangor, MY
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Da Soh Z, Yu M, Betzler BK, Majithia S, Thakur S, Tham YC, Wong TY, Aung T, Friedman DS, Cheng CY. The Global Extent of Undetected Glaucoma in Adults: A Systematic Review and Meta-analysis. Ophthalmology 2021; 128:1393-1404. [PMID: 33865875 DOI: 10.1016/j.ophtha.2021.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 01/30/2023] Open
Abstract
TOPIC Glaucoma is the leading cause of irreversible blindness, despite having good prognosis with early treatment. We evaluated the global extent of undetected glaucoma and the factors associated with it in this systematic review and meta-analysis. CLINICAL RELEVANCE Undetected glaucoma increases the risk of vision impairment, which leads to detrimental effects on the quality-of-life and socioeconomic well-being of those affected. Detailed information on the extent and factors associated with undetected glaucoma aid in the development of public health interventions. METHODS We conducted a systematic review and meta-analysis of population-based studies published between January 1, 1990, and June 1, 2020. Article search was conducted in online databases (PubMED, Web-of-Science), grey literatures (OpenGrey), and nongovernment organization reports. Our outcome measure was the proportion of glaucoma cases that were undetected previously. Manifest glaucoma included any form of glaucoma reported in the original studies and may include primary open-angle glaucoma (POAG), primary angle-closure-glaucoma, secondary glaucoma, or a combination thereof. Undetected glaucoma was defined as glaucoma cases that were undetected prior to diagnosis in the respective study. Random-effect meta-analysis was used to estimate the pooled proportion of undetected glaucoma. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Meta-analysis of Observational Studies in Epidemiology guidelines in our study. RESULTS We identified 61 articles from 55 population-based studies (n = 189 359 participants; n = 6949 manifest glaucoma). Globally, more than half of all glaucoma cases were undetected previously on average in each geographical region. Africa (odds ratio [OR], 12.70; 95% confidence interval [CI], 4.91-32.86) and Asia (OR, 3.41; 95% CI, 1.63-7.16) showed higher odds of undetected glaucoma as compared with Europe. Countries with low Human Development Index (HDI; <0.55) showed a higher proportion of undetected manifest glaucoma as compared with countries of medium to very high HDI (≥0.55; all P < 0.001). In 2020, 43.78 million POAG cases were projected to be undetected, of which 76.7% were in Africa and Asia. DISCUSSION Undetected glaucoma is highly prevalent across diverse communities worldwide and more common in Africa and Asia. Strategies to improve detection are needed to prevent excess visual disability and blindness resulting from glaucoma.
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Affiliation(s)
- Zhi Da Soh
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Bjorn Kaijun Betzler
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
| | - Yih Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Tin Aung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore
| | - David S Friedman
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Ophthalmology & Visual Sciences Academic Clinical Program (Eye ACP), Duke-NUS Medical School, Singapore, Republic of Singapore.
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Upadhyaya S, Agarwal A, Rengaraj V, Srinivasan K, Newman Casey PA, Schehlein E. Validation of a portable, non-mydriatic fundus camera compared to gold standard dilated fundus examination using slit lamp biomicroscopy for assessing the optic disc for glaucoma. Eye (Lond) 2021; 36:441-447. [PMID: 33707762 PMCID: PMC7947938 DOI: 10.1038/s41433-021-01485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/28/2021] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose To evaluate the sensitivity and specificity of a portable non-mydriatic fundus camera to assess the optic disc for glaucoma. Methods We conducted a single-site, cross-sectional, observational, instrument validation study. Non-mydriatic fundus photographs centred at the optic disc were obtained from 276 eyes of 68 glaucoma and 70 normal patients, using a portable fundus camera (Smartscope, Optomed, Oulu, Finland). A senior Glaucoma consultant, masked to the patient’s study participation, performed a gold standard dilated fundus examination to make the diagnosis of glaucoma. Following this, a mydriatic photograph was taken by a standard table-top fundus camera. All the images were digitalized and de-identified by an independent investigator and presented to two remote graders, masked to the patients, their diagnoses, and photographic modality. Based on individual disc characteristics, a diagnosis of screening positive or negative for glaucoma was made. In the end, the independent investigator re-identified the images. Sensitivity and specificity to detect glaucoma with the undilated Smartscope camera was calculated compared to dilated fundus examination. Results Grading remote images taken with the portable non-mydriatic fundus camera showed a sensitivity of 96.3% (95% confidence interval (CI): 91.6–98.8%) and 94.8% (95% CI: 89.7–97.9%) and a specificity of 98.5% (95% CI: 94.9–99.8%) and 97.8% (95% CI: 93.9–99.6%) for the two graders respectively as compared to gold standard dilated fundus examination. Conclusion The non-mydriatic Smartscope fundus images have high sensitivity and specificity for diagnosing glaucoma remotely and thus may be an effective tool for use in community outreach programs.
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Affiliation(s)
- Swati Upadhyaya
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
| | - Anushri Agarwal
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Venkatesh Rengaraj
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Kavitha Srinivasan
- Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | | | - Emily Schehlein
- Kellogg Eye Center, University of Michigan, Ann Arbor, MI, USA
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Idriss BR, Tran TM, Atwine D, Chang RT, Myung D, Onyango J. Smartphone-based Ophthalmic Imaging Compared With Spectral-domain Optical Coherence Tomography Assessment of Vertical Cup-to-disc Ratio Among Adults in Southwestern Uganda. J Glaucoma 2021; 30:e90-e98. [PMID: 33394852 PMCID: PMC8191139 DOI: 10.1097/ijg.0000000000001779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
PRECIS Using optical coherence tomography (OCT) measurements as a reference standard for vertical cup-to-disc ratio (vCDR), a smartphone-based ophthalmic camera has a sensitivity of 67.7% and specificity of 96.7% to detect a vCDR>0.5. PURPOSE The purpose of this study was to assess the performance of a smartphone-based ophthalmic camera system using an Apple iPhone 6S and an adapter, Paxos Scope, to obtain adequate dilated fundus photos to measure clinically useful vCDR cutoffs. PATIENTS AND METHODS Adult patients from a government tertiary level eye hospital in Southwestern Uganda were prospectively recruited from January to April 2019. All patients experienced a comprehensive eye examination, dilated posterior segment indirect ophthalmoscope imaging with the Paxos Scope, and spectral-domain OCT imaging with a Cirrus HD-OCT to measure vCDR. Patients' eyes excluded had media opacities or existing disease precluding a view of the fundus. Fundus images underwent a single masked review to assign vCDR at increments of 0.1. Descriptive statistics, parametric and χ2 tests for significance, repeated measures correlation, κ, receiver operating characteristics curve, and Bland-Altman were used to assess the data. RESULTS Among 467 (consecutive) individuals, fundus photographs acquired with the Paxos Scope demonstrated a 67.7% [95% confidence interval (CI), 63.0-72.0] sensitivity and 96.7% (95% CI, 94.2-98.3) specificity to detect a vCDR>0.5, using OCT as the reference standard. A total of 138 eyes were excluded due to poor imaging acquisition, such as dense cataract, rendering 796 eyes for analysis. The vCDR from graded Paxos Scope images and OCT correlated well with repeated measures correlation of 0.82 (95% CI, 0.77-0.86, P<0.001) and agreement, dichotomized as >0.5 or ≤0.5, was 80.9% (κ=0.63±0.034, P<0.001). Among glaucoma and glaucoma suspects (85 eyes), the sensitivity and specificity dichotomized using vCDR>0.5 were 97.5% (95% CI, 91.3-99.7) and 80.0% (95% CI, 28.4-99.5), respectively. The area under the receiver operating characteristics curve was 0.92 (95% CI, 0.89-0.94) for all eyes and 0.98 (95% CI, 0.78-1.0) for glaucoma and glaucoma suspects. CONCLUSIONS The Paxos Scope produced images that can be reliably used to estimate vCDR, which is closely aligned with the automated algorithm from the OCT optic disc cube scan. The low-cost, ready-to-integrate adapter, and minimal training requirements make it a viable option for population-based screening in low-resource settings.
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Affiliation(s)
- Baimba R. Idriss
- Department of Ophthalmology, Mbarara University of Science and Technology
- Department of Ophthalmology, Military 34 Hospital, Republic of Sierra Leone Armed Forces, Freetown, Western Area, Sierra Leone
| | - Tu M. Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN
| | - Daniel Atwine
- Department of Ophthalmology, Mbarara University of Science and Technology
- Doctors Without Borders Epicentre, Mbarara, Western Region, Uganda
| | | | - David Myung
- Byers Eye Institute, Stanford University
- Veterans Administration Palo Alto Health Care System, Palo Alto, CA
| | - John Onyango
- Department of Ophthalmology, Mbarara University of Science and Technology
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Visual disability among patients attending glaucoma clinic in a tertiary hospital. Int Ophthalmol 2021; 41:1681-1687. [PMID: 33528823 DOI: 10.1007/s10792-021-01724-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/11/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To report visual impairment and blindness among the patients attending a glaucoma clinic in a tertiary university hospital and highlight the possible risk factors that could be addressed later. METHODS A retrospective analysis of the medical records of the patients attending the glaucoma clinic in Ain Shams University Hospitals over a period of one year was conducted. Visual impairment classification was done according to the International Classification of Diseases and Related Health Problems (ICD-11) based on the best-corrected visual acuity in the better-seeing eye. Data including diagnosis, history of previous surgery, and duration of glaucoma were extracted and analyzed. RESULTS The medical records of the first visit of 118 patients (58 males and 60 females) were included in this study. Secondary glaucoma was the most common type presented (38 patients, 32.2%), followed by primary open-angle glaucoma (35 patients, 29.6%). Sixty-seven patients (56.7%) were considered visually impaired, while seven patients (5.9%) were considered blind. Forty-one patients (34.7%) were considered mono-ocular blind. CONCLUSION There is a high incidence of visual impairment and blindness among glaucoma patients presented to the glaucoma clinic in the tertiary hospital. A further nation-wide study and possibly, an early surveillance program for glaucoma are needed.
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Bartelt-Hofer J, Ben-Debba L, Flessa S. Systematic Review of Economic Evaluations in Primary Open-Angle Glaucoma: Decision Analytic Modeling Insights. PHARMACOECONOMICS - OPEN 2020; 4:5-12. [PMID: 31111447 PMCID: PMC7018915 DOI: 10.1007/s41669-019-0141-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Our objective was to review, compare and gain insight into economic evaluations in primary open-angle glaucoma (POAG) with a focus on existing decision analytic models. METHODS A literature review was performed using clinical and specialized databases following best practices. Relevant inclusion criteria included the development of a decision analytic model, the assessment of POAG interventions, and a full economic evaluation in terms of costs and health-related outcomes. Model inputs and settings were extracted, compared and analyzed. Main study incremental outcomes were also reported. RESULTS The literature review identified 22 full articles in alignment with the eligibility criteria for a total of 15 countries and a wide range of years from 1983 to 2018. Interventions included as competing alternatives in the eligible studies were topical medications (33%), screening or diagnosis (33%), surgical interventions (10%), laser trabeculoplasty (10%) and minimally invasive surgeries (3%). Markov models using transition states were the most common type of modeling approach. Cost-utility models using a mid- to long-term time horizon with a national payer perspective were the most frequent type of economic evaluation identified. Model states commonly included disease severity levels, as defined by glaucoma staging systems, and other relevant events such as blindness and death. Authors did not sufficiently justify key modeling assumptions, inputs or the robustness of their findings. CONCLUSIONS Decision analytic models in POAG can reasonably guide future modeling research by revealing common practices, inputs and assumptions. Furthermore, this review revealed evidence gaps in terms of unexplored interventions and treatment sequences.
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Affiliation(s)
| | | | - Steffen Flessa
- Ernst Moritz Arndt University of Greifswald, Greifswald, Germany
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Sabherwal S, John D, Dubey S, Mukherjee S, Menon GR, Majumdar A. Cost-effectiveness of glaucoma screening in cataract camps versus opportunistic and passive screening in urban India: A study protocol. F1000Res 2019; 8:53. [PMID: 31131093 PMCID: PMC6518442 DOI: 10.12688/f1000research.17582.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2019] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Shalinder Sabherwal
- Community Ophthalmology, Shroff's Charity Eye Hospital, New Delhi, Delhi, 110002, India
| | - Denny John
- Evidence Synthesis, Campbell Collaboration, New Delhi, Delhi, 110070, India
| | - Suneeta Dubey
- Glaucoma Services, Shroff's Charity Eye Hospital, New Delhi, Delhi, 110002, India
| | - Saptarshi Mukherjee
- Department of Optometry, Shroff's Charity Eye Hospital, New Delhi, Delhi, 110002, India
| | - Geetha R Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, New Delhi, Delhi, 110029, India
| | - Atanu Majumdar
- Department of Statistics, Shroff's Charity Eye hospital, New Delhi, Delhi, 110002, India
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