Abstract
Abstract: :
Purpose: To test effectiveness and cost–effectiveness of three screening models for pediatric eye care delivery Methods:A population based interventional study in rural south India. We tested three intervention models for screening children– 1) a community worker alone (Model A), 2) community worker and clinical team combined (Model B), and 3) a clinical team alone (Model C). Study villages were randomly allocated to one of three models. Baseline prevalence data of ocular diseases and utilization of services was collected. Predictive values of using community workers and utilization rates for eye care services after screening were compared to explore effectiveness of the three models. Cost effectiveness ratios reflecting the tradeoff between the cost of screening with higher paid personnel and the improved ability to find cases were also estimated to compare the three models with no intervention and with each other. The costs were calculated from the societal perspective. Results: The first screening model (Model A) covered 4,698 children in 28 villages, the second model (Model B) covered 6,508 children in 46 villages and the third model (Model C) covered 9,882 children in 66 villages. The population prevalence for any ocular disorder was 2.6% (95%CI: 2.3, 3.0), and blindness was 6.2 (95%CI: 1.5, 11.0) per 10,000 children. The positive and negative predictive values utilizing community workers were 24.9% and 93.5% respectively. The number of children identified as requiring further care for Models A, B, and C was 464, 65, and 140 respectively and utilization of services after screening was 9.3%, 20.0%, and 33% respectively. Model A is dominated as the societal costs per case found are more than the societal costs per case found using Model B which finds more cases. If only the medical care system costs were considered, Model A is less costly than Model B. Model C is the most costly in the short run, although if the lifetime costs of cases missed are sufficiently high, Model C may be the least costly in the long run. Conclusions: Initial screening by community workers followed by clinical exams appears to be the most cost effective model. Model A is more viable if community workers identify cases better and the population will follow their recommendations for care.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower • clinical (human) or epidemiologic studies: biostatistics/epidemiology methodology • clinical (human) or epidemiologic studies: outcomes/complications