Abstract
Purpose :
Determine economic viability of a government-funded vision screening program for children aged four, and whether it represented efficient allocation of health resources.
Methods :
StEPS universal vision screening program is implemented in 15 Local Health Districts (LHDs) in New South Wales, Australia and carried out by nurses and trained lay screeners in preschools and childcare centres. StEPS data was analysed from 2009 to 2016. Aggregated budgetary data from LHDs was used to estimate a unit cost per screened population. A base-case cost utility model was developed considering cost of implementation and cost of detected and undetected eye disease, with an outcome of quality adjusted years of life (QALY) calculated in $AUD. This study received human research ethics approval and adheres to the tenants of the Declaration of Helsinki.
Results :
StEPS screened 564,825 children in the study period, 19.2% were referred to an eye health professional or to have vision re-tested in 12 months. Referral rate remained steady over the years, with little variation between metropolitan, and rural and regional LHDs. The overall cost of running StEPS was estimated to be approximately $4.5 million per year, equating to a cost per child of $49.21. Based on population and budget projections, the cost per child consistently reduced over time across all LHDs and that by 2020 the total cost of StEPS would be approximately $4.8 million per year, equating to $37.37 per eligible child. Compared to no vision screening, StEPS cost an additional $130.00 per child and yielded, on average, 0.009 additional QALYs, equating to a cost-effectiveness of $14,032 per QALY gained. Once productivity losses associated with blindness (societal perspective) were considered, cost-effectiveness improved ($13,942 /QALY gained). Analysis demonstrated that StEPS reduced blindness and increased participation in society. With increased participation in employment, the increase in wages would exceed the health care costs.
Conclusions :
Modelling estimated that the StEPS program was cost-effective, comparable to other prevention programs and represented good value for money. The results were sensitive to assumptions of: treatment rates; sensitivity, specificity and prevalence; and health-related quality of life of untreated refractive error. Increased confidence in the estimation of these parameters would improve the robustness of the cost-effectiveness results.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.