A cost-benefit analysis of vision screening methods for preschoolers and school-age children

Introduction: The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children. Methods: A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration. Results: All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age ($19,412) and the least for VAS in children 7 to 8 years of age ($15,179). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age ($162) and least for PS in infants 6 to 18 month old ($140). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program. Conclusions: Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.