Comparison of cost-effectiveness of amblyopia screening by optometrists and trained kindergarten staff

Amblyopia is an important cause of weak vision and blindness. A preliminary study on validity of the current screening program in Shahrood City's kindergartens showed that this method may not be efficient enough, especially because of low sensitivity and referral problems. We tried to compare efficiencies and costs of screening by trained staff and optometrists in detecting patients. We conducted a cost-effectiveness analysis using the decision-tree method. We replaced nurses with optometrists to compare costs per detected case by the two screening methods. The number of detected cases and costs per each detected case are compared. Also, the cost-effectiveness of four criteria screening examinations (with different validities) used by optometrists was estimated. Costs per case detected by optometrists and by current screening methods were 270000 and 556000 Rails (Rs), respectively (with baseline examination criteria and 6.4% prevalence). With a lower prevalence of amblyopic patients, CER (cost-effectiveness ratio) will increase in both methods, but the increase in the current screening method is less than the optometric method. In the optometrist method, avoidable costs and savings per detected case vary from 250000 Rs at a prevalence of 7.4% to 1185000 Rs at a prevalence of 1.4%. Sensitivity analysis showed that costs of "monitoring of screening" in the optometrists method and costs of "follow up in the current screening method" have strong effects on CER; CER will decrease by 9.6% and 15%, respectively, if this costs decrease to 25%. The cost, per detected case, of screening amblyopia by optometrists in kindergartens is half that by the current method. In areas with a low prevalence, the efficiency of screening by using optometrists increases remarkably.