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- Cost Effectiveness Analysis
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An assessment of the cost effectiveness of three interventions to address or treat preventable vision impairment in the ROI was conducted. Cost effectiveness analyses were undertaken for: (1) an educational campaign and follow-up screening program in the elderly population; (2) a retinal screening program targeting people diagnosed with diabetes; and (3) a reduction in waiting times for cataract surgery.
The analyses considered the delivery mechanism for each intervention, their effectiveness in reaching the target population, and the effectiveness of related treatment. The analyses incorporated all associated costs and benefits impacted by the intervention.
It was found that an educational program and screening of the elderly population and screening of those with diagnosed diabetes would be cost effective. Because limited data were identified to estimate the cost of reducing cataract surgery waiting lists, the analysis was limited to identifying intervention costs that would result in that intervention being cost effective.
The results for each intervention are detailed in each of the subsections below.
This chapter presents cost effectiveness analyses (CEA) for three hypothetical eye care interventions:
- An educational campaign and screening program targeting the older population, aged 70 years and over;
- An eye screening program targeting people with diagnosed diabetes; and
- A reduction in waiting lists for cataract surgery.
CEAs of the interventions involved an analysis of:
- Program costs, e.g. the cost of screening tests, cost of educational campaign;
- Estimated effects of each intervention, e.g. number of vision loss cases treated, reduced surgery waiting time;
- Outputs from the intervention, e.g. an increase in the number of screening tests, increase in the number of diagnosed vision loss cases; and
- Outcomes associated with outputs, e.g. increase in health care costs associated with diagnosis of additional vision loss cases, avoidance of DALYs from the treatment of detected vision loss cases.
These data are synthesised to estimate the cost effectiveness of each intervention using incremental cost effectiveness ratios (ICER), specifically the cost per DALY averted by the intervention. These ICERs are estimated for two perspectives:
- health care perspective – the analysis includes direct health care costs (of the intervention and associated treatment) only; and
- societal perspective – the analysis also includes the DWL associated with the health care costs (all interventions), and the productivity and informal care costs averted (reduction in cataract surgery waiting lists only).
The WHO ‘Choosing Interventions that are Cost-Effective’ (CHOICE) project uses threshold values in its analyses to assess relative cost effectiveness of an intervention (WHO, 2011). Following recommendations of the Commission of Macroeconomics and Health, WHO uses GDP as a readily available indicator to define three categories of cost effectiveness:
- highly cost effective – cost per DALY averted less than GDP per capita;
- cost effective – cost per DALY averted between one and three times GDP per capita; and
- not cost effective – cost per DALY averted more than three times GDP per capita.
GDP per capita in the ROI was most recently estimated to be €35,801 in 2009 (CSO, 2011). Using WHO criteria, this translates to the following cost effectiveness thresholds:
- highly cost effective – ICER less than €35,801 per DALY averted;
- cost effective – ICER between €35,801 and €107,403 per DALY averted; and
- not cost effective – ICER more than €107,403 per DALY averted.