Risk Management and Healthcare Policy (Feb 2018)
Cost and quality of life of overlooked eye care needs of children
Abstract
Monali S Malvankar-Mehta,1,2 Ryan Wilson,3 Erik Leci,3 Kelly Hatch,4 Sapna Sharan1 1Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Hospital, 2Department of Epidemiology and Biostatistics, 3Schulich School of Medicine and Dentistry, 4Allyn & Betty Taylor Library, Natural Sciences Centre, The University of Western Ontario, London, ON, Canada Background: The objective of this research was to conduct a systematic review and cost analysis to summarize, from the Ministry of Health perspective, the costs families might incur because of their child’s prescription for refractive errors and amblyopia correction.Methods: Databases including MEDLINE, Embase, BIOSIS, CINAHL, HEED, ISI Web of Science, and the Cochrane Library as well as the gray literature were searched. Systematic review was conducted using EPPI-Reviewer 4. Percentage difference in cost of glasses and patches per patient per various diagnoses were computed. The cost of glasses and patches was projected over a 5-year time horizon. Cost-utility analysis was performed.Results: In total, 302 records were retrieved from multiple databases and an additional 48 records were identified through gray literature search. From these, a total of 14 studies (10,388 subjects) were eligible for quantitative analysis. The cost of glasses increased significantly for congenital cataract patients to US$1,820, esotropia patients to US$840, myopes to US$411, amblyopes (mixed) to US$916, anisometropes to US$521, and patients with strabismus to US$728 over a 5-year period making them unaffordable for low-income families. Incremental cost of glasses of congenital cataract patients with delayed treatment was computed to be US$1,690 per health utility gained. Incremental cost of glasses for high refractive error was US$93 per health utility gained in non-compliant children. For amblyopia patients, incremental cost of glasses per quality-adjusted life years gained was US$3,638.Conclusion: Cost of corrective lenses is associated with significant financial burden and thus other means of mitigating costs should be considered. Eyesight problems in children are perceived as low-priority health needs. Thus, educational interventions on substantial visual deficits of not wearing glasses should be offered to families and governmental health agencies. Keywords: systematic review, amblyopia, prescription lens, utility, cost, quality-adjusted life years
