June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Cost-Effectiveness of a School-Based Screening Program in Indonesia for Identifying and Treating Schoolchildren with Refractive Error
Author Affiliations & Notes
  • Rahul Seshadri Iyengar
    Ophthalmology - Roski Eye Institute, University of Southern California Keck School of Medicine, Los Angeles, California, United States
  • Michael Krautmann
    University of Michigan William Davidson Institute, Ann Arbor, Michigan, United States
  • Satyaprabha Kotha
    Eye Health, Helen Keller International, New York, New York, United States
  • John Macom
    Eye Health, Helen Keller International, New York, New York, United States
  • Nicholas Kourgialis
    Eye Health, Helen Keller International, New York, New York, United States
  • Joshua R Ehrlich
    Ophthalmology - Kellogg Eye Center, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States
  • Footnotes
    Commercial Relationships   Rahul Iyengar None; Michael Krautmann None; Satyaprabha Kotha None; John Macom None; Nicholas Kourgialis None; Joshua Ehrlich None
  • Footnotes
    Support  This program was funded by the Standard Chartered Bank’s Seeing is Believing global health program.
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 2784 – A0114. doi:
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      Rahul Seshadri Iyengar, Michael Krautmann, Satyaprabha Kotha, John Macom, Nicholas Kourgialis, Joshua R Ehrlich; Cost-Effectiveness of a School-Based Screening Program in Indonesia for Identifying and Treating Schoolchildren with Refractive Error. Invest. Ophthalmol. Vis. Sci. 2022;63(7):2784 – A0114.

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

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Abstract

Purpose : Indonesia is a rapidly growing county with over 262 million inhabitants, but among highly populated countries it has one of the lowest concentrations of eye care providers. This study evaluates the cost-effectiveness of a program implemented in South Sulawesi, Indonesia that trained schoolteachers to conduct vision screenings, organized in-school evaluations by opticians, and provided free eyeglasses to schoolchildren with refractive error (RE).

Methods : Schoolteachers across 6 districts in South Sulawesi were trained to screen children with possible RE for subsequent evaluation by opticians. All costs associated with designing and implementing the program (administration, training personnel, labor, service delivery, etc.) were assessed. Expenditures and outcomes data were utilized to calculate the cost per disability-adjusted-life-year (DALY) for this intervention using 2010 and 2016 Global Burden of Disease (GBD) weights.

Results : 521 teachers screened 41,212 students across 172 schools in South Sulawesi. 4,506 (10.9%) students failed screening, 2,652 were seen by optometrists, and 2,038 received glasses. 1,854 (41.1%) students that failed screenings did not follow-up. The total program cost was $97,380, which included glasses (39.6%) and labor (23.3%). In districts with school-based refraction services, the costs per student screened, refracted, and receiving glasses were $2.57, $31.33, and $41.40, respectively; costs were $2.04, $59.80, and $73.22 when district services were instead provided centrally. Assuming an 18.4% prevalence of uncorrected refractive error in South Sulawesi, the estimated cost per DALY averted was $89.04 by GBD 2010 weights.

Conclusions : Treating children with correctable RE in limited resource settings can be done cost-effectively through school-based models.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Figure 1: Graphical depiction of the cost per student receiving glasses at district level, allocated by program initiative. This included service delivery (48.7%), training (29.5%), sensitization (12.8%), and Helen Keller programming (HKI Program Mgmt) (9.0%).

Figure 1: Graphical depiction of the cost per student receiving glasses at district level, allocated by program initiative. This included service delivery (48.7%), training (29.5%), sensitization (12.8%), and Helen Keller programming (HKI Program Mgmt) (9.0%).

 

Figure 2: Graphical depiction of the cost per student receiving glasses at district level, allocated by expenditure category. This included eyeglasses (39.6%), meetings (27.3%), labor (23.3%), travel (5.8%), and honorariums (4.1%).

Figure 2: Graphical depiction of the cost per student receiving glasses at district level, allocated by expenditure category. This included eyeglasses (39.6%), meetings (27.3%), labor (23.3%), travel (5.8%), and honorariums (4.1%).

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