Simulating visual outcomes in the developing world: Estimating the burden and assessing the cost-effectiveness of treating glaucoma in the Barbados and Ghana

Visual loss and blindness are estimated to contribute to 8.2 percent of all years of life lived with a disability worldwide, and of the 161 million people that suffer from blindness due to disease, over 90 percent are concentrated in the poorest parts of the developing world. However, with little or no direct measurement, the true epidemiology and burden of visual disease in developing countries is largely unknown. We adapted a previously validated model to estimate the incidence, prevalence, and social and economic burden of primary open angle glaucoma in the context of two developing nation populations; Barbados, which was the source of disease incidence data, and Ghana, whose population may have similar propensity to glaucoma but exhibits different demographic and economic conditions. We then assess the cost-effectiveness of several hypothetical glaucoma screening and treatment interventions in each population. We estimate glaucoma-attributable visual loss results in 0.006 disability adjusted life years (DALY) lost and $100 in net productivity costs per person each year in Barbados. We found that all screening and treatment interventions we assessed would be cost-effective in Barbados. Relative to Barbados, we predict Ghana suffers 36 percent lower prevalence of glaucoma and 60 and 70 percent lower prevalence of visual impairment and blindness, respectively, resulting in annual losses of 0.002 DALYs and $10 in productivity costs per person. No simulated interventions requiring population screening or guideline-level care were cost-effective, but a hypothetical intervention of one-time laser surgery on self-referring patients with limited visual field loss was cost-effective.