Is it worthwhile to conduct a randomized controlled trial of glaucoma screening in the United Kingdom?

Jennifer Burr, Rodolfo Hernández, Craig Ramsay, Maria Prior, Susan Campbell, Augusto Azuara-Blanco, Marion Campbell, Jill Francis, Luke Vale

Research output: Contribution to journalArticle

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Abstract

Objectives To assess the value of conducting a glaucoma screening randomized controlled trial in the UK.
Methods Decision model based economic evaluation and value of information analysis. Model derived from a previous health technology assessment. Model updated in terms of structure and parameter estimates with data from surveys, interviews with members of the public and health care providers and routine sources.
Results On average, across a range of ages of initiating screening (40–60 years), glaucoma prevalence (1–5%), screening uptake (30–100%), and the performance of current case finding, screening was not cost-effective at a £30,000 threshold per quality adjusted life year (QALY) from the perspective of the National Health Service (NHS). The societal value of removing all uncertainty around glaucoma screening is £107 million at a threshold of £20,000 per QALY. For informing policy decisions on glaucoma screening, reducing uncertainty surrounding the NHS and personal social care cost of sight impairment (£74 million) was of most value, followed by reducing uncertainty in test performance (£14 million) and uptake of either screening or current eye care (£8 million each).
Conclusions A glaucoma screening trial in the UK is unlikely to be the best use of research resources. Further research to quantify the costs of sight impairment falling on the NHS and personal social services is a priority. Further development of glaucoma tests and research into strategies to promote the uptake of screening or current eye care such as through the use of a behavioural intervention would be worthwhile.
Original languageEnglish
Pages (from-to)42-51
Number of pages10
JournalJournal of Health Services Research & Policy
Volume19
Issue number1
Early online date2 Oct 2013
DOIs
Publication statusPublished - Jan 2014

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Glaucoma
Randomized Controlled Trials
National Health Programs
Uncertainty
Quality-Adjusted Life Years
Costs and Cost Analysis
Accidental Falls
Research
Biomedical Technology Assessment
Social Work
Health Personnel
Cost-Benefit Analysis
United Kingdom
Public Health
Interviews

Keywords

  • decision analysis
  • health policy
  • public health
  • ophthalmology

Cite this

Is it worthwhile to conduct a randomized controlled trial of glaucoma screening in the United Kingdom? / Burr, Jennifer; Hernández, Rodolfo; Ramsay, Craig; Prior, Maria; Campbell, Susan; Azuara-Blanco, Augusto; Campbell, Marion; Francis, Jill; Vale, Luke.

In: Journal of Health Services Research & Policy, Vol. 19, No. 1, 01.2014, p. 42-51.

Research output: Contribution to journalArticle

Burr, Jennifer ; Hernández, Rodolfo ; Ramsay, Craig ; Prior, Maria ; Campbell, Susan ; Azuara-Blanco, Augusto ; Campbell, Marion ; Francis, Jill ; Vale, Luke. / Is it worthwhile to conduct a randomized controlled trial of glaucoma screening in the United Kingdom?. In: Journal of Health Services Research & Policy. 2014 ; Vol. 19, No. 1. pp. 42-51.
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abstract = "Objectives To assess the value of conducting a glaucoma screening randomized controlled trial in the UK.Methods Decision model based economic evaluation and value of information analysis. Model derived from a previous health technology assessment. Model updated in terms of structure and parameter estimates with data from surveys, interviews with members of the public and health care providers and routine sources.Results On average, across a range of ages of initiating screening (40–60 years), glaucoma prevalence (1–5{\%}), screening uptake (30–100{\%}), and the performance of current case finding, screening was not cost-effective at a £30,000 threshold per quality adjusted life year (QALY) from the perspective of the National Health Service (NHS). The societal value of removing all uncertainty around glaucoma screening is £107 million at a threshold of £20,000 per QALY. For informing policy decisions on glaucoma screening, reducing uncertainty surrounding the NHS and personal social care cost of sight impairment (£74 million) was of most value, followed by reducing uncertainty in test performance (£14 million) and uptake of either screening or current eye care (£8 million each).Conclusions A glaucoma screening trial in the UK is unlikely to be the best use of research resources. Further research to quantify the costs of sight impairment falling on the NHS and personal social services is a priority. Further development of glaucoma tests and research into strategies to promote the uptake of screening or current eye care such as through the use of a behavioural intervention would be worthwhile.",
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