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Huibert Jan Simonsz, Eveline Heijnsdijk, Jan Kik, Andrea Bussé, Mandy Nordmann, Mirjam Verkleij, Erhan Demirel, Harry de Koning; EUSCREEN model for calculation of cost-effectiveness of vision screening programs online. Invest. Ophthalmol. Vis. Sci. 2020;61(7):862.
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Vision screening programs vary in availability, organisation, location, screening tests, screening professionals, referral criteria, data collection and monitoring, which makes prediction and comparison of their cost-effectiveness very difficult. We have developed a disease-health cost-effectiveness model for that purpose, that takes regional diversity and organisational and resource requirements into account.
The MISCAN model simulates the path followed by a child within a vision screening program. The model considers the screening pathway as a whole, including target conditions, age to screen, test sensitivity, choice of test, number of positive tests before referral, choice of screening professional and referral pathways. It is used primarily for cancer screening in adults and was adapted for use in children and for use in low or middle income countries. Currently the model is limited to screening for amblyopia. The model (miscan.euscreen.org) is tested by EUSCREEN country representatives and consortium partners, who first have the model simulate an existing screening program with known data, to check whether its results match real-life results of the screening program for assessment of the accuracy of the prediction.
A premodule was added to assess appropriateness, acceptability and sustainability using the WHO's Sustainable Development Goals and World Bank's Worldwide governance indicators, as in low income countries problems like famine and high infant mortality are prioritized over vision screening. We found that vision screening must be combined with existing high-attendance events like vaccination, general screening, kindergarten or school, to reduce costs and guarantee high coverage. Typical cost-effectiveness output is depicted in the Figure. Expansion of the model is needed to include newborn vision screening, photoscreening, differentiation according to type and severity of amblyopia, costs of diagnostic assessment, effectiveness of treatment, orthoptic training, quality of life and utility.
The EUSCREEN decision-analytic, cost-effectiveness model is an innovative tool to evaluate vision screening programs and to design effective, cost-optimised screening programs in countries where currently none exist. It will assist healthcare providers, policy makers and professionals in their decisions to introduce, modify or disinvest childhood vision screening programs.
This is a 2020 ARVO Annual Meeting abstract.
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