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J Pediatr Ophthalmol Strabismus. 2012 May-Jun;49(3):146-55; quiz 145, 156. doi: 10.3928/01913913-20110823-02. Epub 2011 Aug 30.

The potential cost-effectiveness of amblyopia screening programs.

Author information

  • 1NORC at the University of Chicago, 55 East Monroe St., Chicago, IL 60603, USA. rein-david@norc.org

Abstract

PURPOSE:

To estimate the incremental cost-effective-ness of amblyopia screening at preschool and kindergarten, the costs and benefits of three amblyopia screening scenarios were compared to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten.

METHODS:

A probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from two state programs was programmed. The probability was calculated that no screening and each of the three interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided.

RESULTS:

Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective at a WTP between $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective at a WTP between $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured.

CONCLUSION:

All three screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies.

Copyright 2012, SLACK Incorporated.

PMID:
21877675
[PubMed - indexed for MEDLINE]
PMCID:
PMC3673536
Free PMC Article
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