May 2008
Volume 49, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2008
Cost-Effectiveness of Screening in the Netherlands by Comparison of Historic-Cohort and Birth-Cohort Studies, Before and After Introduction of Population-Based Screening
Author Affiliations & Notes
  • H. J. Simonsz
    Erasmus Med Ctr Rotterdam, Rotterdam, The Netherlands
    Ophthalmology,
  • M. J. C. Eijkemans
    Erasmus Med Ctr Rotterdam, Rotterdam, The Netherlands
    Public Health,
  • J. H. Groenewoud
    Expertise Centre Transition in Care, Rotterdam University, Rotterdam, The Netherlands
  • H. de Koning
    Erasmus Med Ctr Rotterdam, Rotterdam, The Netherlands
    Public Health,
  • Footnotes
    Commercial Relationships  H.J. Simonsz, None; M.J.C. Eijkemans, None; J.H. Groenewoud, None; H. de Koning, None.
  • Footnotes
    Support  Netherlands Organisation for Health Research and Development
Investigative Ophthalmology & Visual Science May 2008, Vol.49, 2579. doi:https://doi.org/
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      H. J. Simonsz, M. J. C. Eijkemans, J. H. Groenewoud, H. de Koning; Cost-Effectiveness of Screening in the Netherlands by Comparison of Historic-Cohort and Birth-Cohort Studies, Before and After Introduction of Population-Based Screening. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2579. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose: : Cost-effectiveness of screening for amblyopia (AM) has been questioned in reports by Snowdon & Stewart-Brown (1997) and the German Institute for Quality & Cost-Effectiveness in Health Care (2007). Data from the Rotterdam AMblyopia Effectiveness Study (RAMSES), the Waterland Study (WS) and the Rotterdam Elderly Study (RES) allow estimation of its cost-effectiveness.

Methods: : In the Netherlands, population-based preverbal screening is performed at 9, 14 and 24 months, preschool at 36, 45 or 54, and 60 months. Total examination time per child is ± 316s for all preverbal and ± 322s for all preschool exams, ± 2’07" per child annually. 1 minute screening costs 400 kE ann. at a birth rate of 180000. The RAMSES was a 7-year, prospective, birth-cohort (N=4626) study of AM. In the WS 1250 patients had been treated by a single orthoptist in the Waterland region in 1968-75. 471 of these were occluded for AM, 203 of these were contacted and 137 re-examined in 2003. In the RES, a population-based cohort study among elderly, we found that the period of bilateral visual impairment (BVI) in later life extends from 0.7 years in healthy 6-year-olds to 1.3 years in insufficiently treated AM.

Results: : In RAMSES AM was detected at age 2.6 for strabismic AM, 2.5 for combined-mechanism AM and 3.9 for anisometropic AM. In the WS these ages were 5.1, 5.7 and 6.6. Approx. 0.8% of RAMSES children had VA > 0.2LogMAR at age 7 with a prevalence of confirmed AM of approx. 3%. The prevalence of occluded children in the WS was estimated at 4.8% (age at detection was 2.7 years later!). In the WS, 30% (estim. prev. 1.6%) of the treated AM cases had VA > 0.2 at age ± 8, 37% at age ± 35. Assuming that a person with BVI costs society 5 kE ann., the reduction of insufficiently treated AM from 1.6% to 0.8% by population-based screening saves 0.6 * 0.8% * 180000 * 5000 = 4320 kE per year. The costs of screening are estimated at 2’07" * 400 kE = 850 kE annually.

Conclusions: : Screening for AM in The Netherlands is cost-effective even if only considering the costs resulting from loss of the better eye in insufficiently treated AM. The delay between cost of screening and yield in senescence is a concern, however. Reduction of QOL in BVI should next be estimated; its reduction in insufficiently treated AM patients who do not loose their better eye was recently estimated at ± 1% using utility analysis with the trade-off method, but was considerably lower with the standard-gamble method.

Keywords: amblyopia • screening for ambylopia and strabismus • clinical (human) or epidemiologic studies: health care delivery/economics/manpower 
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