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Eugene Lowry, Alejandra G de Alba Campomanes; Cost-Effectiveness of Eye-Mobile Follow-up For Preschool Vision Screening. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4494.
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Obtaining high follow-up rates on children referred from preschool vision screening is a challenge. A growing number of screening programs are providing free preschool-based eye-examinations to referred children using an eye-mobile. We investigate the costs and follow-up rates of eye-mobile care necessary to be as cost-effective as referral to community providers.
Two preschool screening programs conducted at the same 37 public preschools from 2009-2013 were compared. In the first program, children were screened with vision charts and referred for community follow-up. In the second, they were screened with auto-refraction and referred to eye-mobile follow-up. We assume screening parameters (referral rate, positive predictive value, and screening cost) are independent of follow-up parameters (follow-up rate and exam cost). We then model an auto-refraction screening program using the screening parameters of the second program paired with either community follow-up rates and costs or eye-mobile follow-up rates and costs. Cases were defined by 2013 AAPOS criteria for significant refractive error or strabismus on cover-uncover test. Cost-effectiveness was defined as cost per case detected. The maximum cost of eye-mobile exams to be equally cost-effective with community referral was determined across a range of follow-up rates.
The auto-refraction screening program had a referral rate of 13.4%, positive predictive value of 49.1% and screening cost of $8.45. Follow-up rate in the community referral program was 59% compared with 55% in the eye-mobile follow-up program (p = 0.41, Fisher exact test). Cost per community-based exam was $151 for an average cost per case detected of $526. At the observed 55% follow-up rate with eye-mobile examinations, eye-mobile exam costs would have to be $143 or less to be as cost-effective as community referral. If eye-mobile follow-up were able to increase follow-up rates to 100%, eye-mobile exams would remain cost-effective to a price of $195.
We do not find evidence that free preschool-based eye examinations significantly increase follow-up rates in children referred from preschool screenings. Organizations providing vision services in the community may compare their individual costs to the cost-effective criteria presented here to determine whether community or eye-mobile referral would be more cost-effective.
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