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Impressum
Modelling the cost-effectiveness of orthoptic screening in kindergarten at the German population level based on empirical data
1Koenig H. H., 2Barry J. C.
1Dept. of Health Economics, University of Ulm, Helmholtzstr. 22, Ulm; 2Dept. of Ophthalmology II, UKT, Schleichstr. 12-16, D-72076 Tübingen
Objective: Orthoptic screening in kindergarten is one option to
improve early detection of untreated amblyopia. The purpose of this study
was to estimate the costs and effects of introducing an orthoptic screening
program in all German kindergartens.
Methods: A decision-analytic model was used. Two screening populations
were considered: (A) all kindergarten children at age 3; (B) all kindergarten
children at age 3 or 4. Data on the prevalence of untreated amblyopia,
on the test characteristics and the costs of orthoptic screening tests,
as well as on participation rates, co-operation rates, and compliance
rates with the ophthalmologic examination were obtained from a field study
in which 1,180 three-year-old children were examined by orthoptists in
121 kindergartens. Data on the screening population and the number of
kindergartens in Germany were obtained from the German Federal Statistical
Office. Results were tested by sensitivity analyses.
Results: In the screening population of three-year-old kindergarten
children (A), 7,207 cases of untreated amblyopia per year could be detected
by orthoptic screening. This corresponds to 79% of all untreated cases
among three-year-old kindergarten children and 43% of all untreated cases
among all children in this age group. The screening program would cost
7.3 million Euro per year. The cost-effectiveness ratio (CER) would be
1,007 Euro per case detected. By extending the screening population to
four-year-old kindergarten children (B), 3,916 additional cases could
be detected. Thereby 66% of all untreated cases of amblyopia of an age
cohort could be detected. Additional costs would be 1.9 million Euro.
The average CER would be 827 Euro per case detected. Compared to (A),
the incremental CER would be 497 Euro per additional case detected.
Conclusions: The decision-analytic model yielded stable results.
The costeffectiveness is likely to be acceptable for decision-makers.
Support: UKT fortuene grant # 447; N