Original Research Cost-effectiveness and cost utility of community screening for glaucoma in urban India Denny John 1,* , Rajul Parikh 2 1 Tutor-Health Economics, Peoples Open Access Education, Initiative (Peoples-uni), 34, Stafford Road, Eccles, Manchester, M30 9ED, United Kingdom 2 Consultant & Glaucoma Specialist, Shreeji Eye Clinic & Palak's, Glaucoma Care Center, Samrat Building, M Vasanji Road, Andheri (East), Mumbai, India article info Article history: Received 3 November 2016 Received in revised form 22 February 2017 Accepted 24 February 2017 Keywords: Primary open-angle glaucoma Angle-closure disease Cost-effectiveness Cost utility Urban India abstract Objectives: Population-based screening for glaucoma has been demonstrated to be cost- effective if targeted at high-risk groups such as older adults and those with a family his- tory of glaucoma, and through use of a technician for conducting initial assessment rather than a medical specialist. This study attempts to investigate the cost-effectiveness of a hypothetical community screening and subsequent treatment programme for glaucoma in comparison with current practice (i.e. with no screening programme but with some opportunistic case finding) in the urban areas of India. Study design: A hypothetical screening programme for both primary open-angle glaucoma and angle-closure disease was built for a population aged between 40 and 69 years in the urban areas of India. Methods: Screening and treatment costs were obtained from an administrator of a tertiary eye hospital in India. The probabilities for the screening pathway were derived from published literature and expert opinion. The glaucoma prevalence rates for urban areas were adapted from the Chennai Glaucoma Study findings. A decision-analytical model using TreeAge Pro 2015 was built to model events, costs and treatment pathways. One-way sensitivity analyses were conducted. Results: The introduction of a community screening programme for glaucoma is likely to be cost-effective, the estimated incremental cost-effectiveness ratio (ICER) values being 10,668.68 when compared with no screening programme and would treat an additional 4443 cases and prevent 1790 person-years of blindness over a 10-year period in the urban areas of India. Sensitivity analyses revealed that glaucoma prevalence rates across various age groups, screening uptake rate, follow-up compliance after screening, treatment costs and utility values of health states associated with medical and surgical treatment of glaucoma had an impact on the ICER values of the screening programme. Conclusions: In comparison with current practice (i.e. without a screening programme but with some opportunistic case finding), the introduction of a community screening pro- gramme for glaucoma for the 40e69 years age group is likely to be relatively cost-effective if implemented in the urban areas of India. © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: 91 09987021553 (mobile). E-mail addresses: djohn1976@gmail.com (D. John), drparikhs@gmail.com (R. Parikh). Available online at www.sciencedirect.com Public Health journal homepage: www.elsevier.com/puhe public health 148 (2017) 37 e48 http://dx.doi.org/10.1016/j.puhe.2017.02.016 0033-3506/© 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.