Cost-effectiveness of School-Based Eye Examinations in Preschoolers Referred for Follow-up From Visual Screening

Abstract

IMPORTANCE Many preschool visual screening programs incorporate school-based comprehensive examinations, but the follow-up rates and cost-effectiveness of this approach are not well studied. OBJECTIVE To determine the follow-up rates and cost-effectiveness of referral to community-based eye care professionals vs to a mobile eye examination unit (mobile follow-up) among preschool children with failed visual screening results. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort cost-effectiveness study with decision analytic modeling and probabilistic sensitivity analysis included 3429 children in 37 public preschools in San Francisco, California, who underwent visual chart screening during the 2009-2012 academic years and 1524 children in the same schools who underwent autorefraction screening during the 2012-2013 academic year. One hundred seventy-five children who underwent visual chart screening were referred for community-based comprehensive eye examinations; 204 who underwent autorefractive screening were referred for preschool-based mobile follow-up. Data were collected from

Identifying and assessing strategies for evaluating the impact of mobile eye health units on health outcomes

“…reported the cost per patient and compared it with the cost of other available methods of retinopathy screening. Lowry & de Alba Campomanes also conducted cost‐effective analysis reporting the cost per case detected and compared the cost of referrals to the mobile eye clinic as opposed to referrals to community‐based eye clinics.…”

Scope and costs of autorefraction and photoscreening for childhood amblyopia—a systematic narrative review in relation to the EUSCREEN project data

“…Fifty-five papers described the implementation and outcomes from large-scale community screening, or screening carried out as a pilot or feasibility studies for potential programmes (see Supplementary Table). Five further papers [20,[55][56][57][58] specifically addressed cost-effectiveness from a theoretical standpoint using published data. Thirty-nine papers (71%) reported photoscreening used as a stand-alone test, although the ABCD protocol used an additional brief history and ʻwarning signs' questionnaire for parents [24].…”

“…Only 13 (24%) studies directly compared different test options [29,49,[55][56][57][58][59][60][61][62][63][64][65][66]. Four (7%) reported schemes where VA was the primary test, with photoscreening as an adjunct or part of a test battery [65][66][67][68].…”

“…Sixty percent of the papers reported diagnostic ʻsuccess' in terms of accurate detection of risk factors, not actual amblyopia or low vision, and only 13% reported actual amblyopia detection [24,57,59,60,64,65,87]. The definition of risk factors varied as published guidelines and definitions, such as the AAPOS [16] or the ABCD Group [28] recommendations, developed over time, so comparisons across the years are difficult.…”

“…Most only considered immediate costs: per test [24,26,32,36,[94][95][96], per case detected (usually cases of risk-factor, not amblyopia) [25,56,57,63,70,83,95,96], or to diagnosis [56,57,63,70,83,95,96]. Longer-term costs were more disparate: savings made by re-screening [57], screening service cost [58,63,71], total cost to a state [73], additional costs of adding photoscreening to established services [24,31,56,65], costs of different types of follow-up [57], costs to third-party providers [24,57,63,70], cost for detection plus follow-up [57,58,70], lifetime costs e.g. Quality Adjusted Life Years (QALYs) [20,31,71].…”