A cost-benefit analysis of vision screening methods for preschoolers and school-age children.
BACKGROUND
The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children.


METHODS
A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration.


RESULTS
All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (19,412 US dollars) and the least for VAS in children 7 to 8 years of age (15,179 US dollars). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (162 US dollars) and least for PS in infants 6 to 18 month old (140 US dollars). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program.


CONCLUSIONS
Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.
Joish
Vijay N
VN
Department of Pharmacy Practice and Sciences, College of Pharmacy, The University of Anzona, Tucson 85721-0284, USA.
Malone
Daniel C
DC
Miller
Joseph M
JM
D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D006801:Humans; D007223:Infant; D018803:Models, Economic; D012680:Sensitivity and Specificity; D014481:United States; D014786:Vision Disorders / Q000175:diagnosis* / Q000191:economics; D015351:Vision Screening / Q000191:economics* / Q000379:methods; D014792:Visual Acuity