A model for cost-effectiveness ratios in amblyopia screening

Background and purpose: In Germany, 750,000 children are born per year who should be screened for developmental visual defects in the age range 24-48 months. However, the established pediatric screening program is not sufficient to prevent amblyopia. The purpose of this study was to examine the cost-effectiveness of alternatives for amblyopia and microtropia screening. Methods: Three options were compared: (1) an orthoptic screening carried out in the field, for instance in kindergartens, (2) an examiner-independent objective apparatus-based screening, and (3) a complete ophthalmological and strabismological examination carried out in a practice. The costs of screening, follow-up examinations and of the treatment were modelled for prevalences of 1% (microtropia) and 5% (amblyopia). The benefit due to treatment was calculated as the result of an avoided whole-person impairment of 3% and 1%. The income related, increased tax and health care payments were used to cover the costs. Results and conclusions: In options (1) and (2) there were favorable cost-effective ratios. The practice-based option 3 was economically less promising. The higher the prevalence was, the higher the resulting cost-effectiveness.