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APHA Scientific Session and Event Listing

Recorded presentation

Alan J. White, PhD, Health Division, Abt Associates, 55 Wheeler St, Cambridge, MA 02138, (617) 349-2489, alan_white@abtassoc.com

Comprehensive eye exams and vision screening assessments are two methods for detecting amblyopia and other visual disorders in children. The purpose of this study is to estimate the cost effectiveness of comprehensive exams. Comprehensive exams cost more than screenings, but have higher rates of detection and treatment. Their cost effectiveness depends on whether the benefits resulting from the higher rates of detection and treatment of amblyopia offset the higher costs.

We assessed cost effectiveness using cost-utility analysis, comparing the marginal benefits of comprehensive exams to marginal costs, including both exam and treatment costs. The model considers the relative performance of exams and screenings, the probability of successful treatment, costs, utility values associated with impaired vision, and patterns of treatment under usual care.

Model parameters were based on an extensive literature review and input from a panel of experts. While the literature is extensive, there are significant gaps in the literature and differences across studies in their estimates of model parameters. Sensitivity analyses were used to examine how results change using different values of model parameters.

Comprehensive exams almost certainly detect more cases of amblyopia than do vision screenings, and, under a wide range of scenarios, comprehensive eye exams appear to be highly cost effective relative to vision screening programs, given existing standards of cost effectiveness. Policymakers should give consideration to programs that would increase the number of preschool children who receive a comprehensive eye exam. There are, however, important gaps in our knowledge, and a need for further research.

Learning Objectives:

• Audience members will be able to discuss the differences between comprehensive eye exams and vision screenings and learn about the effectiveness of these in detecting amblyopia and other visual disorders in children. As a result of this presentation, participants will understand why, despite their higher costs, comprehensive eye exams may be a cost effective intervention for pre-school children. In addition, participants will develop a basic understanding of the methods used in cost-effectiveness analysis.

Keywords: Vision Care, Child Health Promotion

Related Web page: www.abtassoc.com/reports/Cost_Effectiveness_of_Eye_Exams.pdf

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation