Resource use and costs for a glaucoma screening program in Austria: An 8-year review. A cost-consequence analysis based on the Salzburg-Moorfields Collaborative Glaucoma Study

PURPOSE. The aim of this study is to report costs, detection rates, and resources needed for detection of primary open angle glaucoma and related diseases in a glaucoma screening program in Salzburg, Austria, over a period of 8 years. METHODS. The Salzburg-Moorfields Collaborative Glaucoma Study performed a complete ophthalmologic examination on a total of 4864 subjects within a study period of approximately 8years (98 months). The total numbers reported are total number of subjects screened at the initial examination and follow-up examinations; total working hours and estimated working hours per visit for one ophthalmologist and two medical assistants; direct costs per visit; detection rates for subjects; and corresponding costs per true positive case diagnosed with definite primary open angle glaucoma (POAG), early POAG, POAG suspect, ocular hypertension (OHT), and glaucoma artefact. RESULTS. Within the screening period of 98 months, a total of 9427 examinations and second verification checks were performed: 5466 at the initial examination, 404 at the 1-year follow-up, 815 at the 2-year follow-up, 339 at the 3-year follow-up, 225 at the 4-year follow-up, 1059 at the 5-year follow-up, 996 at the 6-year follow-up, 118 at the 7-year follow-up, and 5 at the 8-year follow-up. The total amount of time spent for screening was 23,814 working hours. We estimate the costs per visit at EUR 123 for each initial examination, EUR 28 for each second confirmation check, and EUR 95 per follow-up examination. The following detection rates were observed: definite POAG: 1.7% (95% Cl: 1.3-2.2%), early POAG: 2.9% (95% Cl: 2.3-3.5%), POAG suspect: 8.5% (95% Cl: 7.6-9.4%), OHT: 2.2% (95% Cl: 1.7-2.7%), glaucoma artefact or other causes: 5.8% (95% Cl: 5.1-6.6%), normal cases: 79% (95% Cl: 78-80%). CONCLUSIONS. Direct costs per visit were considerably higher than those reported in the Netherlands or the United Kingdom. If a health care provider decides to perform a glaucoma screening within this setting, the costs for the detection of a new case are EUR 7250 for definite POAG, EUR 4250 for early POAG, EUR 1450 for POAG suspect, EUR 5600 for OHT, EUR 2100 for glaucoma artefact case, and EUR 156 for a normal case.