List of articles published on economics of Childhood Blindness

S: 1. Invest Ophthalmol Vis Sci. 2002 Oct;43(10):3209-15. Economic evaluation of orthoptic screening: results of a field study in 121 German kindergartens. Konig HH, Barry JC, Leidl R, Zrenner E. Department of Health Economics, University of Ulm, Ulm, Germany. [email protected] PURPOSE: The purpose of this study was to analyze the cost-effectiveness of an orthoptic screening program in kindergarten children. METHODS: An empiric cost-effectiveness analysis was conducted as part of a field study of orthoptic screening. Three-year-old children (n = 1180) in 121 German kindergartens were screened by orthoptists. The number of newly diagnosed cases of amblyopia and amblyogenic factors (target conditions) was used as the measure of effectiveness. The direct costs of orthoptic screening were calculated from a thirdparty-payer perspective based on comprehensive measurement of working hours and material costs. RESULTS: The average cost of a single orthoptic screening examination was 12.58 Euro. This amount consisted of labor costs (10.99 Euro) and costs of materials and traveling (1.60 Euro). With 9.9 children screened on average per kindergarten, average labor time was 279 minutes per kindergarten, or 28 minutes per child. It consisted of time for organization (46%), traveling (16%), preparing the examination site (10%), and the orthoptic examination itself (28%). The total cost of the screening program in all 121 kindergartens (including ophthalmic examination, if required) was 21,253 Euro. Twenty-three new cases of the target conditions were detected. The cost-effectiveness ratio was 924 Euro per detected case. Sensitivity analysis showed that the prevalence and the specificity of orthoptic screening had substantial influence on the costeffectiveness ratio. CONCLUSIONS: The data on the cost-effectiveness of orthoptic screening in kindergarten may be used by such third-party payers as health insurance or public health services when deciding about organizing and financing preschool visionscreening programs. 2. Pediatrics. 2002 Apr;109(4):e59. Economic evaluation of different methods of screening for amblyopia in kindergarten Konig HH, Barry JC. Department of Health Economics, University of Ulm, Ulm, Germany. [email protected] OBJECTIVE: To compare the cost-effectiveness of 5 methods of screening for untreated amblyopia in kindergarten from a third-party-payer perspective: A) uncorrected monocular visual acuity testing with pass threshold > or =0.5 (20/40) and < or =1 line difference between eyes; B) same as A, but pass threshold > or =0.6 (20/32); C) same as A, plus cover tests and examination of eye motility and head posture; D) same as C, but pass threshold > or =0.6 (20/32); and E) refractive screening without cycloplegia using the Nikon Retinomax autorefractor. METHODS: A decision-analytic model was used with a time horizon until diagnostic examination. According to the model, all 3-year-old children were screened in kindergarten with 1 of the screening methods. Children with positive screening results were referred to an ophthalmologist for diagnostic examination. Children with inconclusive screening results were either referred to an ophthalmologist directly (option 1) or rescreened by the same method after 1 year and referred to an ophthalmologist if rescreening was positive or inconclusive (option 2). Screening test characteristics and costs were estimated on the basis of a field study in which 1180 3year-old children were examined by orthoptists in 121 German kindergartens. RESULTS: Compared with methods A option 1 (A-1), B-1, C-1, C-2, E-1, and E-2, there was at least 1 other method that was both less costly and more effective. The average costs per detected case were lowest for method A-2 (878 Euro), followed by methods B-2 (886 Euro), D-2 (908 Euro), and D-1 (965 Euro). When these methods were compared with each other, the additional costs per extra case detected were 1058 Euro (B-2 vs A-2), 1359 Euro (D-2 vs B-2), and 13 448 Euro (D-1 vs D-2). CONCLUSIONS: Monocular visual acuity screening with rescreening of inconclusive results had a favorable cost-effectiveness. By adding additional test items, few more cases could be detected. Because of a great proportion of false-negative, false-positive, and inconclusive results, refractive screening was less effective with an unfavorable cost-effectiveness. 3. Strabismus. 2000 Dec;8(4):291-5 The cost-effectiveness of screening strategies for amblyopia: a