A Review to Populate A Proposed Cost-Effectiveness Analysis of Glaucoma Screening in Sub-Saharan Africa

Figures & data

Table 1. Population studies of glaucoma prevalence in Africa.

Authors	Kyari et al.^Citation3	Ashaye et al.^Citation39	Budenz et al^Citation5	Rotchford at al^Citation39	Rotchford et al^Citation40	Bastawrous et al,^Citation41
Country and year of publication	Nigeria 2015	Nigeria 2013	Ghana 2013	South Africa (Temba) 2003	South Africa (Zulus) 2002	Kenya 2018
Number of participants screened	13591	811	5603	839	1005	2171
Age screened	40 years and above	40 years and above	40 years and above	40 years and above	40 years and above	50 years and above
Number with glaucoma	682	59	362	55	51	88
Prevalence of glaucoma	5.02%	7.3% Adjusted for age:6.9%	6.8%	5.3%	4.5%	4.3%
ISGEO category 1	268 (39.3)	16(27.1)	316 (87.2%)	12(21.8%)	Not documented	64 (72.7)
ISGEO category 2	378 (55.4)	39(66.1)	23 (6.4%)	30(54.5%)		22(25.0%)
ISGEO category 3	36 (5.3)	4 (6.8)	23(6.4%	13(23.6%)		2 (2.3%)
Unilaterally blind, n (%)	365 (38%)	5(8.4%)	52 (14.4%)	32(58.2%)	12(31.7%) 2.1% age sex-adjusted of the prevalence of glaucoma	Visual Impairment = 21.6%
Bilaterally blind, n (%)	136 (20%)	3(5.1%)	9 (2.5%)	18(32.7%)	41(3.2%) of these were blind from glaucoma 0.9% of the prevalence of glaucoma	5.7%
POAG	208 (86.0%) This is a proportion of all the primary glaucoma	50(84.7%)	342 (94.5)	31(56.4%) (adjusted prevalence of 2.9%	28 (2.7%)	83(94.3)
PACG	35(14.0%)	2(3.4%)	9 (2.5%)	5(9.1%)	5(9.8%)	1 (1.14%)

Table 2. Summary of reviewed data necessary to populate a cost-effectiveness model.

Data to populate Model	Review questions and Objectives	Findings and Interpretation
Prevalence of glaucoma in Sub- Saharan Africa (SSA)	What is the prevalence of glaucoma in population based studies in Africa?	Prevalence of glaucoma in SSA is very high compared to other populations. It ranges from 4.3% – 7.2%
Prevalence of glaucoma among African descents	What is the prevalence of glaucoma in population based studies among African descents?	Prevalence range of 7.0–9.6%
Severity of glaucoma at presentation	What is the severity of glaucoma at presentation in SSA?	Unilateral blindness 15.0–52.2% Bilateral blindness: 18.0–56.0%.
Compliance with follow up after screening	What proportion of patients have follow up care after testing positive for glaucoma during screening outreach?	17.6% and 32.5%.*
Frequency Doubling Technique	How does FDT perform in early and moderate glaucoma?	96% sensitivity and 96% specificity for moderate glaucoma and 85% sensitivity and 90% specificity for early glaucomatous visual field loss
Clinical effectiveness of glaucoma treatment	How effectively can glaucoma be managed in SSA?	0.66 (95% CI of 0.61–0.71) pooled estimates for medical treatment. Surgical treatment (trabeculectomy): 0.73 (95%CI 0.65–0.80). Lasers: 0.39 (95% CI 0.27–0.54)
Cost of treatment	What is the cost of treating glaucoma across SSA?	Medical: A range of USD 273–483. Surgical: USD283.

In press

Kyari F, Entekume G, Rabiu M, et al. A population-based survey of the prevalence and types of glaucoma in Nigeria: results from the Nigeria national blindness and visual impairment survey. BMC Ophthalmol. 2015;15(1):176.doi:10.1186/s12886-015-0160-6.

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Rotchford AP, Kirwan JF, Muller MA, ohnson GJ Roux P. Temba glaucoma study: a population-based cross-sectional survey in urban South Africa. Ophthalmology. 2003;110(2):376–382. doi:10.1016/S0161-6420(02)01568-3.

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Budenz DL, Barton K, Whiteside-de Vos J, et al. Prevalence of glaucoma in an urban West African population: the tema eye survey. JAMA Ophthalmol. 2013;131(5):651–658.doi:10.1001/jamaophthalmol.2013.1686.

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Rotchford AP, Johnson GJO. Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa. Arch Ophthalmol (Chicago, Ill 1960). 2002;120(4):471–478. doi:10.1001/archopht.120.4.471.

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Rotchford AP. Glaucoma in Zulus: a population-based cross-sectional survey in a rural district in South Africa. Arch Ophthalmol (Chicago, Ill 1960). 2002;120(4):471–478. doi:10.1001/archopht.120.4.471.

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