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R. J. Adams, J. R. Drover, P. G. Kean, M. L. Courage; The Economics of Pediatric Eye/Vision Screening: Calculating the Cost-Effectiveness of a Large-Scale Preschool Vision Screening Program. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4835.
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© ARVO (1962-2015); The Authors (2016-present)
Because of the plasticity of the developing visual system, early eye and vision screening has been advocated for preventing long term visual pathology, notably amblyopia. However, there is substantial debate over the effectiveness and the economics of vision screening in preschool children. Many screening tools are ineffective, and/or it is perceived that the cost of screening exceeds the expected benefits of early treatment. Here, we report on the development of a new comprehensive battery of screening tests and provide an economic analysis of the effectiveness of various test combinations
946 Canadian preschool children (n = 946) were screened with an extensive battery of the latest pediatric tests of visual acuity, refractive error (Welch Allyn SureSight), contrast sensitivity, stereoacuity, and ocular alignment/motility. A child who failed any test was reexamined with the entire battery, and if s/he again failed any test, was then referred (n = 152) for a gold standard optometric exam. Based on the exam, we calculated measures of clinical effectiveness/validity (sensitivity, specificity positive/negative predictive value) for each possible combination of tests. The 10 most accurate combinations (validity > 85%) were then submitted for analysis of cost effectiveness. Included in this analysis were the "real" monetary amounts required to fund all components of the screening program, including labor, transportation, equipment, materials, and professional fees.
Based on the model of Konig et al (Strabismus, 2000), cost effectiveness ratios (CER) were calculated for each combination’s ability to identify a child with a previously undetected vision disorder. For the 10 combinations, CER ranged from $ 175 to $ 313 (CAN) per detected child (2006: $1 CAN = $0.88 US). In general, 3-test combinations were most cost effective ($205 CAN per detected child). Autorefraction and ocular alignment/motility were always included in the most accurate and the most economical combinations
Our data suggest that given the significant medical, social, educational, and rehabilitative costs of failing to detect early visual pathology, the cost ($250 CAN) per previously undiagnosed child is relatively inexpensive. However, it must be emphasized that cost effectiveness depends critically upon the inclusion of valid pediatric tests which evaluate different dimensions of vision.
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