Cost-Effectiveness Analysis of Atropine for Treating Myopia Progression in Children

Abstract

Purpose : Low concentration atropine is efficacious for controlling myopia progression in children, but its cost-effectiveness remains unknown. This study aims to determine the cost-effectiveness of using atropine 0.05%, 0.025%, and 0.01% based on LAMP study.

Methods : We analyzed data (N=438) of children between the ages of 4 to 12 years from the low-concentration atropine for myopia progression (LAMP) study; a randomized, double-blinded, placebo-controlled trial of treating myopia progression with atropine. Changes in spherical equivalent (SE) and axial length (AL) were measured for the different concentrations. The data from the study was used to design a Markov model to compare the costs and effectiveness of the varying concentrations of atropine in controlling myopia progression. Costs included patient out of pocket costs of medical examination and medications which consisted of cost of consultation, follow-up visits, optometric services (refraction), specialized ophthalmic services, spectacles, and loss of productivity. Adopting a societal perspective, analysis was performed over a time horizon of 20 years. The main outcome was the incremental cost-effectiveness ratio (ICER), defined as costs per spherical equivalent reduction. Model parameters were varied within plausible ranges of values to determine their impact on the model in sensitivity analysis.

Results : The incremental cost-effectiveness ratios associated with atropine 0.05%, 0.025%, and 0.01% were $119/spherical equivalent, $186/spherical equivalent, and $247/spherical equivalent reduction respectively. Atropine 0.05% and 0.025% were dominant, and hence more cost-effective than atropine 0.01%. Atropine 0.05% and 0.025% were the most cost-effective concentrations in 4 to 7 year-old children, with 0.05% being the optimum concentration in probabilistic sensitivity analysis. We observed that, the cost-effectiveness of atropine was dose-dependent, with higher concentrations being more cost-effective. In older children (8 to 12 years), atropine 0.05% was the only cost-effective concentration.

Conclusions : Among the concentrations studied, atropine 0.05% was the most cost-effective strategy for controlling myopia progression in children.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.