Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

Asare, Afua Oteng; Maurer, Daphne; Wong, Agnes M. F.; Ungar, Wendy J.; Saunders, Natasha

doi:10.1016/j.jpeds.2021.10.020

Cited by 12 publications

(7 citation statements)

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“…Transition probabilities were derived from published data in the literature and Statistics Canada and from published and unpublished patient-level data from the Kindergarten Vision Testing Program (Table 1). The risk of developing amblyopia or experiencing treatment failure increased with increasing age …”

Section: Methodsmentioning

confidence: 99%

“…Costs from earlier years were inflated to 2019 CAD and USD using the health care component of the Consumer Price Index. 74 Table 2 summarizes the resource use, unit costs, and data sources 15,16,33,53,57,[70][71][72][73][75][76][77][78][79][80] used in the model. Valuation of key costs is described in eMethods 7 in Supplement 1.…”

Section: Costsmentioning

confidence: 99%

“…[26][27][28][29] Despite recommendations and availability of universal funding, the uptake of vision services in Ontario has been poor. 16,30 Therefore, in 2018, the Ontario Ministry of Health introduced guidelines for administering vision screening in senior kindergartens (children aged 5 years) by public health departments. 31 Introducing school-based screening has been difficult because of increasing costs and budgeting constraints.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

et al. 2023

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ImportanceScreening for amblyopia in primary care visits is recommended for young children, yet screening rates are poor. Although the prevalence of amblyopia is low (3%-5%) among young children, universal screening in schools and mandatory optometric examinations may improve vision care, but the cost-effectiveness of these vision testing strategies compared with the standard in primary care is unknown.ObjectiveTo evaluate the relative cost-effectiveness of universal school screening and mandated optometric examinations compared with standard care vision screening in primary care visits in Toronto, Canada, with the aim of detecting and facilitating treatment of amblyopia and amblyopia risk factors from the Ontario government’s perspective.Design, Setting, and ParticipantsAn economic evaluation was conducted from July 2019 to May 2021 using a Markov model to compare 15-year costs and quality-adjusted life-years (QALYs) between school screening and optometric examination compared with primary care screening in Toronto, Canada. Parameters were derived from published literature, the Ontario Schedule of Benefits and Fees, and the Kindergarten Vision Testing Program. A hypothetical cohort of 25 000 children aged 3 to 5 years was simulated. It was assumed that children in the cohort had irreversible vision impairment if not diagnosed by an optometrist. In addition, incremental costs and outcomes of 0 were adjusted to favor the reference strategy. Vision testing programs were designed to detect amblyopia and amblyopia risk factors.Main Outcomes and MeasuresFor each strategy, the mean costs per child included the costs of screening, optometric examinations, and treatment. The mean health benefits (QALYs) gained were informed by the presence of vision impairment and the benefits of treatment. Incremental cost-effectiveness ratios were calculated for each alternative strategy relative to the standard primary care screening strategy as the additional cost required to achieve an additional QALY at a willingness-to-pay threshold of $50 000 Canadian dollars (CAD) ($37 690) per QALY gained.ResultsSchool screening relative to primary care screening yielded cost savings of CAD $84.09 (95% CI, CAD $82.22-$85.95) (US $63.38 [95% CI, US $61.97-$64.78]) per child and an incremental gain of 0.0004 (95% CI, −0.0047 to 0.0055) QALYs per child. Optometric examinations relative to primary care screening yielded cost savings of CAD $74.47 (95% CI, CAD $72.90-$76.03) (US $56.13 [95% CI, $54.95-$57.30]) per child and an incremental gain of 0.0508 (95% CI, 0.0455-0.0561) QALYs per child. At a willingness-to-pay threshold of CAD $50 000 (US $37 690) per QALY gained, school screening and optometric examinations were cost-effective relative to primary care screening in only 20% and 29% of iterations, respectively.Conclusions and RelevanceIn this study, because amblyopia prevalence is low among young children and most children in the hypothetical cohort had healthy vision, universal school screening and optometric examinations were not cost-effective relative to primary care screening for detecting amblyopia in young children in Toronto, Canada. The mean added health benefits of school screening and optometric examinations compared with primary care screening did not warrant the resources used.

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Section: Methodsmentioning

confidence: 99%

Section: Costsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

et al. 2023

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“…Likewise, inequalities in access to ocular health care for sight-threatening or life-threatening eye diseases have been identified in impoverished and wealthier countries [7][8][9][10][11][12][13]. Wide ranges of disparities in ocular health are reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…Substantial disparities exist in vision screening coverage for preschool children due to socioeconomic differences [14]. Access is poor to comprehensive eye examinations for children living in the most materially deprived neighborhoods [8]. Fewer strabismus surgeries were performed, and patients were less likely to receive secondary operations, in a socioeconomically deprived cohort [7].…”

Section: Introductionmentioning

confidence: 99%

Urban inequality: a hypothetic risk factor for myopia

Nouraeinejad¹

2022

Med Hypothesis Discov Innov Optom

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Background: Myopia is a common refractive error with an expected increase in prevalence. Inequalities in access to ocular health care for sight-threatening or life-threatening ocular diseases have been described. Urbanization is a risk factor for both the incidence and progression of myopia; however, socioeconomic inequalities in urban settings are a new concept in myopia incidence.Hypothesis: Considering the proven impact of inequalities existing in general and ocular health, urban inequality could be a new risk factor for both the incidence and progression of myopia. Inequalities in urban infrastructure vary between countries; however, there are currently various manifestations of urban inequality, and scholars are concerned about intra-urban inequality as a public health risk. Considering the significant influence of urban inequality on health of children, and because myopia develops and progresses faster during childhood, the effect of urban inequality on myopia must be examined. Although urban inequality could be a putative risk factor for myopia, a causal relationship should be investigated. However, myopia is multifactorial in etiology, originating from the interaction of environmental and genetic factors. Thus, causality between urban inequality and myopia should be investigated through a randomized, controlled trial with strict matching of genetic backgrounds and environmental factors. Conclusions: Several risk factors for myopia have been proposed, and studies have confirmed causal relationships with most of these factors. Considering the proven impact of urban inequality on both general and ocular health, experimental studies are necessary to confirm the possible causal relationship between urban inequality and myopia. Certainly, there will be substantial challenges in the implementation phase.

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Adopting More Precise Metrics to Move Everyone Closer to Eye Health

Ross,

Higginbotham

2024

JAMA Ophthalmol

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Socioeconomic Status and Vision Care Services in Ontario, Canada: A Population-Based Cohort Study

Cited by 12 publications

References 58 publications

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Cost-effectiveness of Universal School- and Community-Based Vision Testing Strategies to Detect Amblyopia in Children in Ontario, Canada

Urban inequality: a hypothetic risk factor for myopia

Adopting More Precise Metrics to Move Everyone Closer to Eye Health

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