Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project

BackgroundGlaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres.MethodsThe analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded.Results1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273.ConclusionGlaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.

Investigating the management of unaccounted for water for Lilongwe Water Board, Malawi

Lilongwe Water Board (LWB) is currently unable to meet Lilongwe City's water demand as evidenced by low supply coverage (65%) and intermittent water supply in the city. One of the major challenges is high levels of unaccounted for water (UFW) reported at 37% (2012), higher than the recommended 23% for developing countries. This study, done in Lilongwe City (Areas 15, 18 and 28), investigated water losses and partitioned UFW into real and apparent losses. Data collection involved data logging for pressures and flows at selected points in the network, meter testing, and water audits. This study estimated an average UFW of 37.5% for Lilongwe City and 33%, 44% and 20%, respectively, in the specific study areas (Areas 15, 18 and 28). The UFW in Lilongwe City was higher than recommended and was also higher than recommended in Areas 15 and 18 but within the acceptable limit for Area 28. High UFW levels in Areas 15 and 18 were mainly driven by real losses. The LWB should consider partitioning of its UFW to establish the main drivers, implement active leak detection programme and active pressure management in areas with high pressures.