Clinical Ophthalmology (Jun 2022)
Photorefraction Screening Plus Atropine Treatment for Myopia is Cost-Effective: A Proof-of-Concept Markov Analysis
Abstract
Chuen Yen Hong,1 Matt Boyd,2 Graham Wilson,3 Sheng Chiong Hong4 1Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 2Adapt Research Ltd, Reefton, New Zealand; 3Matai Medical Research Institute, Gisborne, New Zealand; 4oDocs Eye Care, Dunedin, New ZealandCorrespondence: Chuen Yen Hong, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand, Tel +6421 209 1230, Email [email protected]: The prevalence of myopia is increasing globally, putting individuals at risk of myopia-associated visual impairment. Low-dose atropine eye drops have been found to safely reduce the risk of progression from myopia to higher levels of myopia and pathological states. In New Zealand, school children have an eye check at age 11. In this study, we aimed to estimate the cost-effectiveness of introducing photorefractive screening for myopia at age 11 in the New Zealand context, with atropine 0.01% eye drops treatment for those screening positive.Patients and Methods: A Markov cohort simulation was used to model the impact of screening plus atropine compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER), with utility measured in quality-adjusted life-years (QALYs). Multivariate sensitivity analyses were carried out to investigate factors influencing cost-effectiveness.Results: The ICER for screening plus atropine was NZ$1590 (95% CI 1390, 1791) per QALY gained, with 7 cases of lifetime blindness prevented per 100,000 children screened.Conclusion: Screening for myopia with photorefraction at age 11 and atropine 0.01% eye drop treatment of children screening positive is likely to be cost-effective. These results suggest that a real-world trial and cost-effectiveness analysis would be worth considering in New Zealand.Keywords: cost-benefit analysis, photorefractive screening, myopia, atropine
