title: Cost-effectiveness of School-Based Eye Examinations in Preschoolers Referred for Follow-up From Visual Screening.
abstract: Many preschool visual screening programs incorporate school-based comprehensive examinations, but the follow-up rates and cost-effectiveness of this approach are not well studied.
  
  
  
  To determine the follow-up rates and cost-effectiveness of referral to community-based eye care professionals vs to a mobile eye examination unit (mobile follow-up) among preschool children with failed visual screening results.
  
  
  
  This retrospective cohort cost-effectiveness study with decision analytic modeling and probabilistic sensitivity analysis included 3429 children in 37 public preschools in San Francisco, California, who underwent visual chart screening during the 2009-2012 academic years and 1524 children in the same schools who underwent autorefraction screening during the 2012-2013 academic year. One hundred seventy-five children who underwent visual chart screening were referred for community-based comprehensive eye examinations; 204 who underwent autorefractive screening were referred for preschool-based mobile follow-up. Data were collected from October 1, 2009, to May 29, 2013, and analyzed from June 30, 2013, to January 16, 2016.
  
  
  
  Cost-effectiveness of community-based vs mobile follow-up standardized for referral method.
  
  
  
  Of the 175 children referred for community-based follow-up (91 boys [52.0%]; 84 girls [48.0%]; mean [SD] age, 3.8 [0.7] years), 104 attended (59.4%). Of 204 children referred for mobile follow-up (89 boys [43.6%]; 115 girls [56.4%]; mean [SD] age, 4.1 [0.6] years), 112 attended (54.9%). Costs per case detected were $664 and $776, respectively. In univariate analysis, mobile follow-up was equally cost-effective if it increased the follow-up rate to 73% or if its costs were reduced by at least 27%. In multivariate analysis with Monte Carlo simulation, community-based follow-up was more cost-effective than mobile follow-up in 88% of simulated cases and had typical savings of $112 (95% CI, -$77 to $368) per case detected.
  
  
  
  Community-based eye care professionals may provide more cost-effective care than a mobile eye examination unit visiting the preschool among children with failed preschool-based visual screening.
authors.affiliation: Department of Ophthalmology, University of California, San Francisco.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Lowry
authors.affiliation: Department of Ophthalmology, University of California, San Francisco.
authors.forename: Alejandra G
authors.initials: AG
authors.lastname: de Alba Campomanes
mesh_terms: D002675:Child, Preschool; D019058:Community Networks / Q000191:economics / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008952:Mobile Health Units / Q000191:economics / Q000458:organization & administration; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012029:Refraction, Ocular / Q000502:physiology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015351:Vision Screening / Q000191:economics* / Q000295:instrumentation; D014792:Visual Acuity / Q000502:physiology