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Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity
J Javitt1, R Dei Cas, Y P Chiang
1Worthen Center for Eye Care Research, Georgetown University Medical Center, Washington, DC 20007.
Insights
Early screening and cryotherapy for retinopathy of prematurity (ROP) is cost-effective, saving millions and preventing blindness in premature infants. This treatment strategy significantly reduces vision loss in newborns.
Area of Science:
- Ophthalmology
- Neonatology
- Health Economics
Background:
- Retinopathy of prematurity (ROP) is a primary cause of blindness in premature infants.
- A National Eye Institute trial showed cryotherapy significantly reduces blindness in severe ROP (stage 3+).
Purpose of the Study:
- To determine the cost-effectiveness of cryotherapy for retinopathy of prematurity (ROP).
- To evaluate ROP screening strategies for premature infants.
Main Methods:
- A microsimulation model was used to assess cost-effectiveness.
- Simulations analyzed three birth weight subpopulations (500-749g, 750-999g, 1000-1249g).
- Three screening frequencies were evaluated: weekly, biweekly, and monthly.
Main Results:
- Timely ROP screening and treatment are predicted to yield 3899-4648 quality-adjusted life years.
- Net governmental savings are estimated at $38.3-$64.9 million per annual US birth cohort.
- Cost per quality-adjusted life year gained ranges from $2488 to $6045, varying by screening strategy.
Conclusions:
- Properly timed ROP screening and treatment are cost-saving interventions.
- This approach can prevent approximately 320 infants annually from lifelong blindness.
Background:
Retinopathy of prematurity (ROP) is the leading cause of blindness among premature infants. A recent National Eye Institute-sponsored prospective, multicenter trial investigating the use of cryotherapy for treatment of ROP demonstrates a significant reduction in blindness and low vision for patients with sight-threatening (stage 3+) ROP.
Method:
A microsimulation model is presented to determine the cost-effectiveness of cryotherapy for ROP. Simulations are performed for three subpopulations of premature infants with birth weights 500 through 749 g, 750 through 999 g, and 1000 through 1249 g, and for three screening strategies--weekly, biweekly, and monthly.
Results:
Appropriately timed screening for and treatment of ROP is predicted to result in a gain of 3899 to 4648 quality-adjusted-life-years and a net governmental budgetary savings of $38.3 to $64.9 million for each annual US birth cohort of 28,321 premature infants (500 through 1249 g). The cost per quality-adjusted-life-year gained is $2488 to $6045, depending on different screening strategies.
Conclusions:
Of greatest importance is the finding that properly timed screening and treatment for ROP is not only cost saving but may save approximately 320 infants per year from a lifetime of blindness.