Glaucoma Control Strategies in Sub-Saharan Africa: A Review of the Clinical and Health Economic Evidence

Andrew F. Smith, Guy Negretti, Aaron Mascaro, Desta Bokre, Helen Baker, Kazim Dhalla, Ian E. Murdoch
2018 Ophthalmic Epidemiology  
Purpose: A review of the effectiveness, costs and cost-effectiveness of detection and treatment strategies for glaucoma control in Sub-Saharan Africa (SSA) was conducted. Methods: Detailed searches were performed using the Ovid Medline; Ovid Embase; The Cochrane Library; Web of Science; Scopus; and LILACS databases up to September 2016. The key Medical Subject Heading (MeSH) search terms used included: glaucoma, diagnosis, treatment, effectiveness, costs, cost-effectiveness and Sub-Saharan
more » ... nd Sub-Saharan Africa. Effectiveness was measured as the proportion of study participants with an intra-ocular pressure (IOP) less than or equal to 22 mm Hg. Results: A total of 5,658 records were examined with 48 papers identified. The sensitivity and specificity of portable instruments or smart phone technologies to detect glaucomatous changes ranged from 58.3% to 93.8% and from 82.4% to 96.8%, respectively. The overall effect size for various glaucoma interventions was: 0.39 (95% C.I. 0.27-0.54, I²=64.85, P=0.036) for laser trabeculoplasty; 0.56 (95% C.I. 0.23-0.84, I²=85.74, P=0.001) for drainage implant devices; 0.66 (95% C.I. 0.61-0.71, I²= 0.00, P=0.402) for medical management; and 0.73 (95% C.I. 0.65-0.80, I²= 93.25, P=0.000) for all other non-drainage tube surgical interventions, including trabeculectomy surgery and the use of anti-metabolites. The mean annual cost of anti-glaucoma drugs across SSA was US$ 394, with a mean direct non-medication cost per year of US$ 54, and a mean surgical cost per year of US$ 283. Conclusions: While effective glaucoma control interventions exist their widespread use and diffusion across SSA remains challenging principally due to low per capita income levels and high glaucoma treatment costs. Word Count: 250
doi:10.1080/09286586.2018.1501499 pmid:30059637 fatcat:ne6elkx37zdbpl5orn5yx7t7ke