Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project.

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.

Cost and effectiveness of an eye care adherence program for Philadelphia children with significant visual impairment.

The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.