Cost-effectiveness of screening for amblyopia among kindergarten children in China
Yu-Ting Gu1, Bing Shi2, Dan-Lin Li3
1College of Pharmacy, Jinan University, Guangzhou, China.
Insights
Preschool amblyopia screening in China is cost-effective, with an incremental cost-effectiveness ratio below the willingness-to-pay threshold. Screening at ages 4 or 5 may offer even better outcomes for children.
Area of Science:
- Public Health
- Ophthalmology
- Health Economics
Background:
- Cost-effectiveness analyses of amblyopia screening are predominantly from Western countries.
- The economic viability of preschool amblyopia screening programs in China remains under-explored.
- This study addresses the need for localized cost-effectiveness data for China.
Purpose of the Study:
- To evaluate the cost-effectiveness of a kindergarten-based amblyopia screening program for 3-year-old children in China.
- To compare the strategy of screening versus no screening from a third-party payer perspective.
- To determine if implementing such a program aligns with China's willingness-to-pay threshold.
Main Methods:
- A decision tree model combined with a Markov model was utilized.
- The analysis compared costs and quality-adjusted life years (QALYs) between screening and non-screening groups.
- Data on costs, transition probabilities, and health utilities were sourced from Chinese expert opinions and existing literature.
Main Results:
- The base-case analysis yielded an incremental cost-effectiveness ratio (ICER) of $17,466 per QALY, significantly below China's willingness-to-pay (WTP) threshold of $38,223 per QALY.
- Sensitivity analyses identified amblyopia prevalence, transition probability from untreated amblyopia to healthy, and discount rate as key factors influencing the results.
- Probabilistic sensitivity analysis indicated a 92.56% likelihood that screening is a cost-effective strategy.
Conclusions:
- Kindergarten-based amblyopia screening for 3-year-old children is a cost-effective intervention in China.
- Delaying screening to ages 4 or 5 could potentially yield even more favorable cost-effectiveness results.
- The findings support the implementation of preschool amblyopia screening programs in China.
Objective:
Current cost-effectiveness analyses of amblyopia screening are mainly from western countries. It remains unclear whether it is cost-effective to implement a preschool amblyopia screening programme in China. Our study aimed to evaluate the cost-effectiveness of a hypothetical kindergarten-based amblyopia screening versus non-screening among 3-year-old children.
Methods:
We developed a decision tree combined with a Markov model to compare the cost and effectiveness of screening versus non-screening for 3-year-old children from a third-party payment perspective. The primary outcomes were quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER). Costs were obtained from expert opinions in different regions of China. Transition probabilities and health utilities were mainly based on published literature and open sources. Sensitivity analyses were performed to assess the impact of parameters' uncertainty on results.
Results:
Base-case analysis demonstrated that the ICER of screening versus non-screening was $17,466/QALY, well below the WTP threshold ($38,223/QALY) for China. One-way sensitivity analysis showed that the prevalence of amblyopia, the transition probability per year from untreated amblyopia to healthy, and the discount rate were the top three factors. The likelihood of cost-effectiveness of screening compared with non-screening was 92.56%, according to probabilistic sensitivity analysis. Scenario analysis also indicated that ICER was lower than the WTP threshold even if the time horizon was shortened or the screening was delayed to the age of 4 or 5.
Conclusions:
Amblyopia screening could be considered a cost-effective strategy compared to non-screening for 3-year-old children in China. Screening for children at the age of 4 or 5 may even yield better results.
