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Cost-effectiveness of monotherapy and combination therapy for myopia control in Chinese children
Jinghui Wang1, Xuan Li1,2, Meinan He1
1Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China.
Background:
Myopia poses a major public health and economic burden in China, necessitating cost-effectiveness evaluations of control strategies. We aimed to assess cost-effectiveness of single/combined myopia control in children and adolescents to optimise strategies.
Methods:
We conducted a network meta-analysis to evaluate the efficacy of myopia control interventions in Chinese children (aged 6-18 years). Annual changes in axial length (AL) and spherical equivalent refraction (SER) were the primary outcomes. Additionally, we used a decision-analytic Markov model with clinical and cost data from China to evaluate 16 myopia control strategies for eight-year-old children over eight years from a patient perspective, with 3% discounting. Strategies included monotherapies and combined therapies. Main outcomes were incremental cost per unit reduction in myopic shift (i.e. SER) or AL elongation, compared with single-vision lenses (SVLs). Markov cohort analysis simulated the proportion of individuals progressing to high myopia under various strategies. We assessed robustness through deterministic and probabilistic sensitivity analyses. We performed subgroup analyses by onset age (6, 10, and 12 years) and regional economic development.
Results:
For SER reduction, outdoor activity was cost-effective (incremental cost-effectiveness ratio = USD -18.29/dioptre (D)). At higher willingness-to-pay thresholds, 0.01% atropine combined with defocus incorporated multiple segment (DIMS) (USD 660.74/D) and repeated low-level red-light therapy (RLRL) (USD 895.36/D) were cost-effective. For AL reduction, outdoor activity (USD -42.68/mm) and DIMS (USD 672.73/mm) were cost-effective at lower thresholds, while RLRL (USD 2011.32/mm) was preferred at higher thresholds. Compared with monotherapy, combination interventions improved preventive efficacy against high myopia. Subgroup analyses confirmed that the cost-effectiveness ranking was preserved across onset ages and regional economic settings.
Conclusions:
Under limited budget conditions, outdoor activities and defocus spectacles represent advantageous cost-effective treatment options. When the budget is sufficient, RLRL may be considered a promising option pending confirmation of its long-term safety and effectiveness, and 0.01% atropine combined with DIMS is the preferred cost-effective option. Our analysis provides evidence-based guidance for clinicians and families in selecting effective myopia control strategies.
