Cost-Effectiveness Analysis of Myopia Progression Interventions in Children

Abstract

ImportanceSeveral interventions exist for treating myopia progression in children. While these interventions’ efficacy has been studied, their cost-effectiveness remains unknown and has not been compared.ObjectiveTo determine cost-effective options for controlling myopia progression in children.Design, Setting, and ParticipantsIn this cost-effectiveness analysis, a Markov model was designed to compare the cost-effectiveness of interventions for controlling myopia progression over 5 years from a societal perspective in a simulated hypothetical cohort of patients aged 10 years with myopia. Myopia interventions considered included atropine eye drops, 0.05% and 0.01%, defocus incorporated multiple segment spectacles, outdoor activity, soft contact lenses (daily disposable and multifocal), rigid gas-permeable contact lenses, progressive addition lenses, bifocal spectacle lenses, orthokeratology, highly aspherical lenslets (HALs), and red light therapy; all interventions were compared with single-vision lenses. Deterministic and probabilistic sensitivity analysis determined the association of model uncertainties with the cost-effectiveness. Costs were obtained from the charges of the Hospital Authority of Hong Kong and The Chinese University of Hong Kong Eye Center.Main Outcome and MeasuresThe mean costs (in US dollars) per child included the cost of hospital visits, medications, and optical lenses. The outcomes of effectiveness were the annual spherical equivalent refraction (SER) and axial length (AL) reductions. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy relative to single-vision lenses over a time horizon of 5 years.ResultsOutdoor activity, atropine (0.05%), red light therapy, HALs, and orthokeratology were cost-effective. The ICER of atropine, 0.05%, was US $220/SER reduction; red light therapy, US $846/SER reduction; and HALs, US $448/SER reduction. Outdoor activity yielded a savings of US $5/SER reduction and US $8/AL reduction. Orthokeratology resulted in an ICER of US $2376/AL reduction.Conclusions and RelevanceThese findings suggest that atropine eye drops, 0.05%, and outdoor activity are cost-effective for controlling myopia progression in children. Though more expensive, red light therapy, HALs, and orthokeratology may also be cost-effective. The use of these interventions may help to control myopia in a cost-effective way.

Myopia Control: Are We Ready for an Evidence Based Approach?

“…Since the US Food and Drug Administration (FDA) and most regulatory authorities, with some few exceptions, have not granted regulatory approval for the use of any pharmacological agents for myopia control, in most countries, atropine is used off-label. Manufacturing atropine in low doses in bulk quantities would likely make it cost-effective [ 131 ].…”

“…Of note, the costs for optical interventions for myopia control are generally high, and thus only a small proportion of individuals globally will be able to access them. Agyekum et al compared the cost-effectiveness of various myopia interventions and estimated atropine 0.05% to reach an incremental cost-effectiveness ratio (ICER) of 220 USD per SER reduction [ 131 ]. In comparison, ICER for HALs was 448 USD per SER reduction and the that for OK lenses was 2376 USD/SER reduction.…”

Efficacy and Safety of 0.03% Atropine Eye Drops in Controlling Myopia Progression: A One-Year Prospective Clinical Study

“…This analysis concluded that the use of 0.01% atropine is a cost-effective approach to managing myopia progression. Additionally, another analysis by Agyekum et al [ 41 ] compared 13 different interventions for controlling myopia progression in children, which included pharmacological agents, special contact lenses and spectacle lenses, using a Markov model. This economic evaluation suggested that atropine, particularly at a concentration of 0.05%, and outdoor activity are among the most cost-effective strategies for managing myopia progression.…”

Myopia control: Seeing beyond efficacy

“…Notwithstanding the different survey methods and the 8 years between publications, the differences in parental attitudes between countries are profound 102,103 . Ophthalmologists sometimes make glib statements in publications regarding contact safety 104,105 that are not supported by the data presented above 95,96,99,100 . This may be driven by their own professional experience and seeing only the most serious cases of microbial keratitis.…”