title: The potential cost-effectiveness of amblyopia screening programs.
abstract: OBJECTIVE
  To estimate the incremental cost-effective-ness of amblyopia screening at preschool and kindergarten, the costs and benefits of three amblyopia screening scenarios were compared to no screening and to each other: (1) acuity/stereopsis (A/S) screening at kindergarten, (2) A/S screening at preschool and kindergarten, and (3) photoscreening at preschool and A/S screening at kindergarten.
  
  
  METHODS
  A probabilistic microsimulation model of amblyopia natural history and response to treatment with screening costs and outcomes estimated from two state programs was programmed. The probability was calculated that no screening and each of the three interventions were most cost-effective per incremental quality-adjusted life year (QALY) gained and case avoided.
  
  
  RESULTS
  Assuming a minimal 0.01 utility loss from monocular vision loss, no screening was most cost-effective with a willingness to pay (WTP) of less than $16,000 per QALY gained. A/S screening at kindergarten alone was most cost-effective at a WTP between $17,000 and $21,000. A/S screening at preschool and kindergarten was most cost-effective at a WTP between $22,000 and $75,000, and photoscreening at preschool and A/S screening at kindergarten was most cost-effective at a WTP greater than $75,000. Cost-effectiveness substantially improved when assuming a greater utility loss. All scenarios were cost-effective when assuming a WTP of $10,500 per case of amblyopia cured.
  
  
  CONCLUSIONS
  All three screening interventions evaluated are likely to be considered cost-effective relative to many other potential public health programs. The choice of screening option depends on budgetary resources and the value placed on monocular vision loss prevention by funding agencies.
authors.affiliation: NORC at the University of Chicago, 55 East Monroe St., Chicago, IL 60603, USA. rein-david@norc.org
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.forename: John S
authors.initials: JS
authors.lastname: Wittenborn
authors.forename: Xinzhi
authors.initials: X
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Song
authors.forename: Jinan B
authors.initials: JB
authors.lastname: Saaddine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000550:Amblyopia / Q000175:diagnosis* / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005382:Financing, Personal; D017048:Health Care Costs; D006801:Humans; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D015351:Vision Screening / Q000191:economics*; D055815:Young Adult