Authors: Stephanie Cheon, Amanda Ross-White, Christine Law

Author Disclosure Block: S. Cheon: None. A. Ross-White: None. C. Law: None.

Abstract Body:

Purpose: The goal of pediatric vision screening is early identification of amblyopia or amblyogenic factors to decrease individual and societal disease burden. However, there is currently no national strategy or policy regarding pediatric vision screening within Canada. Furthermore, the cost-benefit of implementing total population pediatric vision screening has been debatable. We thus aimed to systematically review economic evaluations of universal vision screening programs for children in various healthcare systems around the world, with subsequent characterization and comparison of programs and their associated costs. 

Study Design: Systematic review. 

Methods: Articles published in English between January 2008 and September 2018 relevant to vision screening recommendations in the pediatric population were searched in Medline, Embase, the National Bureau of Economic Research, EconLit, and Business Source Premier. Two reviewers independently conducted title and abstract followed by full-text screening, using the pre-determined inclusion and exclusion criteria. All non-original articles and studies describing programs that targeted specific or sub-populations such as children with specific diseases, were excluded. Disagreements between reviewers were resolved through discussion and consensus established. Data was extracted from each article and compared for program features, study population, and economic evaluation of the program. All costs were converted to 2018 United States dollars for direct comparison.

Results: Our search returned 264 studies; 16 were eligible for inclusion in the review. The target ages of programs ranged from 6 months to 17 years of age. The majority of programs were school-based. The average cost of programs was $8.24/child (range: $0.12-$27.78). Half of all included articles described programs based in USA, with an average cost of $10.75/child (range: $0.14-$27.74). The remaining articles' country of publication consisted of UK, Taiwan, India, Iran, China, and Thailand, with an average program cost of $4.91/child (range: $0.12-$27.78). The devices and assessment tools used for screening varied across studies, with more than half employing instrument-based techniques that utilize technology such as photoscreeners and autorefractors; the average program cost was $11.35/child (range: $0.14-$27.78). The remaining articles used traditional methods of assessment including Snellen charts and direct ophthalmoscopy, costing the program on average $7.08/child (range: $0.12-$27.74). The percentage of children identified to have abnormal screens was highest in programs whose screening was conducted by eye care professionals as opposed to lay screeners, but the program cost did not affect rate of identification.

Conclusions: There is large variability in the average cost to implement a pediatric vision screening program. Throughout the world the average cost can increase comparatively to over 200 times. The average program cost per child in USA is more than double the average cost of programs elsewhere in the world. However, the percentage of children identified as having abnormal screens is not influenced by program cost. We hope our exploratory work will lay the framework for development of cost-effective programs within our Canadian public healthcare system.