Economic analyses of two screening programs for ophthalmic conditions (amblyopia and macular degeneration): Process and impact in a UK context

Separate tenders for cost-effectiveness analyses of screening programs for amblyopia and strabismus (A&S), and for age-related macular degeneration (AMD) were put out by the Health Technology Programme in the UK. This paper summarises the methods and results of the two evaluations, discusses potential approaches to interpreting and acting on the results, describes current routes by which the analyses could impact on policy and practice, and looks at new routes that could improve research translation (and hence, health service efficiency). Both analyses used a decision modelling framework to evaluate a range of alternative screening programs, which were calibrated and analysed probabilistically (‘probabilistic calibration'). In both cases, limited data were identified to populate the models, though the resulting uncertainty around the cost-effectiveness results can be differentially interpreted. The analyses were published as HTA monographs, though there is no explicit link between such analyses and decisions relating to policy and practice. A national screening committee provides guidance on issues relating to screening, which has a role with respect to the implementation nationally and locally co-ordinated screening programs. This paper charts the progression of the amblyopia and AMD screening analyses through the policy pathway is described, and assesses how the observed process could be improved.