Tulosta

Glaukooman seulonta

Näytönastekatsaukset
11.8.2014
Anja Tuulonen

Näytön aste: D

Glaukooman seulonnasta ei ole olemassa systemaattisia katsauksia tai (satunnaistettuja) tutkimuksia, jotka osoittaisivat glaukooman seulonnan suoran tai epäsuoran vaikutuksen näkövammaisuuden tai glaukooman aiheuttamien rakenteellisten ja toiminnallisten vaurioiden ehkäisemiseksi tai potilaille tärkeiden lopputulosten saavuttamiseksi. Myöskään seulonnan kustannusvaikuttavuutta simuloivat mallit eivät ole johtopäätöksiltään yhteneviä. Koulutuksen tai hoitosuositusten ei ole osoitettu parantavan glaukoomien diagnostiikkaa.

Katsaus «Tuulonen A. Economic considerations of the diagnosis and management for glaucoma in the developed world. Curr Opin Ophthalmol 2011;22:102-9 »1

PubMed by October 2010 with key words Glaucoma and cost* No randomized screening trials were found of the clinical effectiveness nor cost-effectiveness of screening for preventing visual disability. Simulation models of cost-effectiveness of systematic screening for glaucoma in Finland and in UK agree partly and suffer from unreliability of input data to be able to draw definitive conclusions.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: hyvä

Suomalainen simulaatiomalli «Vaahtoranta-Lehtonen H, Tuulonen A, Aronen P ym. Cost effectiveness and cost utility of an organized screening programme for glaucoma. Acta Ophthalmol Scand 2007;85:508-18 »2

An organized screening program was modeled and compared to opportunistic case finding using a simulation model in a population aged 50–79 years at 5 year intervals. The cost of one QALY gained by screening was €9023 (5 % discount rate). During 20 years, in the population of 1 million the cumulative costs exceeding opportunistic case finding in Finland were €30 million avoiding 930 years of visual disability in 701 persons. The results were sensitive to the estimates of specificity of screening tests, screening cost, discount rate, follow-up cost, prevalence of suspected glaucoma and prevalence of glaucoma. An organized screening program could be a cost-effective strategy especially in older age groups in Finland. Also patients with glaucoma diagnosis were screened in the model. Therapy was not initiated or was withdrawn from patients with ocular hypertension, i.e. only manifest glaucoma was treated. The threshold specificities of diagnostic tests for screening being less costly and more efficient were 96-98 %.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: hyvä

Systemaattinen katsaus ja simulaatiomalli «Burr JM, Mowatt G, Hernández R ym. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess 2007;11:ii»3

The model simulated that screening might be cost-effective in a 50-year-old cohort at a prevalence of 4 % with a 10-year screening interval. General population screening at any age would not to be cost-effective. Selective screening of groups with higher prevalence (family history, black ethnicity) might be worthwhile, although this would only cover 6 % of the population. Extension to include other at-risk cohorts (e.g. myopia and diabetes) would include 37 % of the general population, but the prevalence is then too low for screening to be considered cost-effective. In addition to prevalence, the cost-effectiveness of the screening program was highly sensitive to the perspective on costs. In this model, cost-effectiveness was not particularly sensitive to the accuracy of screening tests. False-positives were not considered in the model.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Systemaattinen katsaus ad lokakuu 6, 2011 «Ervin AE, Boland MV, Myrowitz EH ym. Screening for Glaucoma: Comparative Effectiveness. Comparative Effectiveness Review Number 59 AHRQ Publication No. 12-EHC037-EF, April 2012; http://www.effectivehe»4

MEDLINE®, Embase, LILACS, and CENTRAL through October 6, 2011, and MEDLINE and CENTRAL (March 2, 2011) and screened an existing database to identify relevant systematic reviews. There is limited evidence on the effects of screening for OAG

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Australialainen simulaatiomalli «Taylor HR, Crowston J, Keeffe J ym. Tunnel vision: the economic impact of primary open angle glaucoma – a dynamic economic model. Melbourne: Centre for Eye Research Australia; 2008. http://www.»5

The results suggested the if diagnosis rates of opportunistic case finding could be improved by educating clinicians (without considering costs of training), it would be associated with a rise in eye care costs as more people were treated. Simultaneously, disability adjusted life years (DALYs) would decrease

  • Tutkimuksen laatu: heikko
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Tutkimus «Ratnarajan G, Newsom W, French K ym. The effect of changes in referral behaviour following NICE guideline publication on agreement of examination findings between professionals in an established glauc»6

In the UK the real-life impact of evidence-based NICE indicated no improvement in accuracy for detecting an abnormal IOP and there was a reduction in accuracy in detecting an abnormal optic disc.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Tutkimus «Shah S, Murdoch IE. NICE - impact on glaucoma case detection. Ophthalmic Physiol Opt 2011;31:339-42 »7

The post-NICE guide line rising number of referrals did not lead to indentifying more glaucoma patients.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Tutkimus «Callewaert S, Fieuws S, Stalmans I ym. Appraisal of optic disc stereo photos pre- and post-training session. Bull Soc Belge Ophtalmol 2010;316:27-32 »8

24 resident were trained to with 50 eyes of varying glaucoma dagame to detect progression. The mean pre-training kappa of 0.35 improved to 0.5 post-training.

  • Tutkimuksen laatu: kelvollinen
  • Sovellettavuus suomalaiseen väestöön: kohtalainen

Tämä teksti on linkitetty seuraaviin artikkeleihin:

  • Glaukooma 1

Kirjallisuutta

  1. Tuulonen A. Economic considerations of the diagnosis and management for glaucoma in the developed world. Curr Opin Ophthalmol 2011;22:102-9 «PMID: 21192264»PubMed
  2. Vaahtoranta-Lehtonen H, Tuulonen A, Aronen P ym. Cost effectiveness and cost utility of an organized screening programme for glaucoma. Acta Ophthalmol Scand 2007;85:508-18 «PMID: 17655612»PubMed
  3. Burr JM, Mowatt G, Hernández R ym. The clinical effectiveness and cost-effectiveness of screening for open angle glaucoma: a systematic review and economic evaluation. Health Technol Assess 2007;11:iii-iv, ix-x, 1-190 «PMID: 17927922»PubMed
  4. Ervin AE, Boland MV, Myrowitz EH ym. Screening for Glaucoma: Comparative Effectiveness. Comparative Effectiveness Review Number 59 AHRQ Publication No. 12-EHC037-EF, April 2012; http://www.effectivehealthcare.ahrq.gov/ehc/products/182/1026/CER59_Glaucoma-Screening_Final-Report_20120524.pdf «http://www.effectivehealthcare.ahrq.gov/ehc/products/182/1026/CER59_Glaucoma-Screening_Final-Report_20120524.pdf»1
  5. Taylor HR, Crowston J, Keeffe J ym. Tunnel vision: the economic impact of primary open angle glaucoma – a dynamic economic model. Melbourne: Centre for Eye Research Australia; 2008. http://www.cera.org.au «http://www.cera.org.au»2
  6. Ratnarajan G, Newsom W, French K ym. The effect of changes in referral behaviour following NICE guideline publication on agreement of examination findings between professionals in an established glaucoma referral refinement pathway: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project. Br J Ophthalmol 2013;97:210-4 «PMID: 23111242»PubMed
  7. Shah S, Murdoch IE. NICE - impact on glaucoma case detection. Ophthalmic Physiol Opt 2011;31:339-42 «PMID: 21545475»PubMed
  8. Callewaert S, Fieuws S, Stalmans I ym. Appraisal of optic disc stereo photos pre- and post-training session. Bull Soc Belge Ophtalmol 2010;316:27-32 «PMID: 21305810»PubMed
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