TY - JOUR
T1 - The cost-effectiveness of different visual acuity screening strategies in three European countries
T2 - A microsimulation study
AU - Heijnsdijk, Eveline A.M.
AU - Verkleij, Mirjam L.
AU - for the EUS€REEN Foundation
AU - Carlton, Jill
AU - Horwood, Anna M.
AU - Fronius, Maria
AU - Kik, Jan
AU - Sloot, Frea
AU - Vladutiu, Cristina
AU - Simonsz, Huibert J.
AU - de Koning, Harry J.
N1 - Funding Information:
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 733352.
Publisher Copyright: © 2022 The Authors
PY - 2022/8
Y1 - 2022/8
N2 - Childhood vision screening programmes in Europe differ by age, frequency and location at which the child is screened, and by the professional who performs the test. The aim of this study is to compare the cost-effectiveness for three countries with different health care structures. We developed a microsimulation model of amblyopia. The natural history parameters were calibrated to a Dutch observational study. Sensitivity, specificity, attendance, lost to follow-up and costs in the three countries were based on the EUSCREEN Survey. Quality adjusted life-years (QALYs) were calculated using assumed utility loss for unilateral persistent amblyopia (1%) and bilateral visual impairment (8%). We calculated the cost-effectiveness of screening (with 3.5% annual discount) by visual acuity measurement at age 5 years or 4 and 5 years in the Netherlands by nurses in child healthcare centres, in England and Wales by orthoptists in schools and in Romania by urban kindergarten nurses. We compared screening at various ages and with various frequencies. Assuming an amblyopia prevalence of 36 per 1,000 children, the model predicted that 7.2 cases of persistent amblyopia were prevented in the Netherlands, 6.6 in England and Wales and 4.5 in Romania. The cost-effectiveness was €24,159, €19,981 and €23,589, per QALY gained respectively, compared with no screening. Costs/QALY was influenced most by assumed utility loss of unilateral persistent amblyopia. For all three countries, screening at age 5, or age 4 and 5 years were optimal. Despite differences in health care structure, vision screening by visual acuity measurement seemed cost-effective in all three countries.
AB - Childhood vision screening programmes in Europe differ by age, frequency and location at which the child is screened, and by the professional who performs the test. The aim of this study is to compare the cost-effectiveness for three countries with different health care structures. We developed a microsimulation model of amblyopia. The natural history parameters were calibrated to a Dutch observational study. Sensitivity, specificity, attendance, lost to follow-up and costs in the three countries were based on the EUSCREEN Survey. Quality adjusted life-years (QALYs) were calculated using assumed utility loss for unilateral persistent amblyopia (1%) and bilateral visual impairment (8%). We calculated the cost-effectiveness of screening (with 3.5% annual discount) by visual acuity measurement at age 5 years or 4 and 5 years in the Netherlands by nurses in child healthcare centres, in England and Wales by orthoptists in schools and in Romania by urban kindergarten nurses. We compared screening at various ages and with various frequencies. Assuming an amblyopia prevalence of 36 per 1,000 children, the model predicted that 7.2 cases of persistent amblyopia were prevented in the Netherlands, 6.6 in England and Wales and 4.5 in Romania. The cost-effectiveness was €24,159, €19,981 and €23,589, per QALY gained respectively, compared with no screening. Costs/QALY was influenced most by assumed utility loss of unilateral persistent amblyopia. For all three countries, screening at age 5, or age 4 and 5 years were optimal. Despite differences in health care structure, vision screening by visual acuity measurement seemed cost-effective in all three countries.
UR - http://www.scopus.com/inward/record.url?scp=85132847684&partnerID=8YFLogxK
U2 - 10.1016/j.pmedr.2022.101868
DO - 10.1016/j.pmedr.2022.101868
M3 - Article
C2 - 35801001
AN - SCOPUS:85132847684
SN - 2211-3355
VL - 28
JO - Preventive Medicine Reports
JF - Preventive Medicine Reports
M1 - 101868
ER -