Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system

• Published in: European journal of public health Vol. 31; no. 1; pp. 7 - 12
• Main Authors: Van der Ploeg, Catharina P B, Grevinga, Manon, Eekhout, Iris, Vlasblom, Eline, Lanting, Caren I, van Minderhout, H M (Ellen), van Dijk – van der Poel, Jolande, van den Akker-van Marle, M Elske, Verkerk, Paul H
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-02-2021; Oxford Publishing Limited (England)
• Subjects: Children; Children & youth; Childrens health; Costs; Cross-sectional studies; Diagnosis; Economic aspects; Eye examinations; Health care; Health services; Medical care, Cost of; Medical screening; Pediatric research; Population studies; Public health; Screening; Testing; Vision; Vision disorders in children; Netherlands
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckaa098

Abstract
Background
Little is known about costs and effects of vision screening strategies to detect amblyopia. Aim of this study was to compare costs and effects of conventional (optotype) vision screening, photoscreening or a combination in children aged 3–6 years.
Methods
Population-based, cross-sectional study in preventive child health care in The Hague. Children aged 3 years (3y), 3 years and 9 months (3y9m) or 5–6 years (5/6y) received the conventional chart vision screening and a test with a photoscreener (Plusoptix S12C). Costs were based on test duration and additional costs for devices and diagnostic work-up.
Results
Two thousand, one hundred and forty-four children were included. The estimated costs per child screened were €17.44, €20.37 and €6.90 for conventional vision screening at 3y, 3y9m and 5/6y, respectively. For photoscreening, these estimates were €6.61, €7.52 and €9.40 and for photoscreening followed by vision screening if the result was unclear (combination) €9.32 (3y) and €9.33 (3y9m). The number of children detected with amblyopia by age were 9, 14 and 5 (conventional screening), 6, 13 and 3 (photoscreening) and 10 (3y) and 15 (3y9m) (combination), respectively. The estimated costs per child diagnosed with amblyopia were €1500, €1050 and €860 for conventional vision screening, €860, €420 and €1940 for photoscreening and €730 (3y) and €450 (3y9m) for the combination.
Conclusions
Combining photoscreening with vision screening seems promising to detect amblyopia in children aged 3y/3y9m, whereas conventional screening seems preferable at 5/6y. As the number of study children with amblyopia is small, further research on the effects of these screening alternatives in detecting children with amblyopia is recommended.