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Photoscreening preschoolers is successful at saving both sight and money
According to a study, the government can save as much as $8,000 per child if photoscreening tests can be incorporated into the health care regimen earlier.
SEATTLE — Testing children for visual defects at an early age with a sensitive photoscreening device was found to be not only highly effective, but cost-effective as well, according to a researcher here.
In a study presented at the annual meeting of the American Association for Pediatric Ophthalmology and Strabismus, researchers compared the costs and benefits of photoscreening (PS) with visual acuity screening (VAS) in children up to 8 years of age.
“We found that the government would save an additional $8,000 per child if children were tested about 4 years sooner than they currently are,” said Vijay Joish, MS, a doctoral candidate at the University of Arizona.
According to Mr. Joish, detecting a disorder early would save the government a significant sum on management once a progressive condition is spotted.
“Photoscreening tests can accurately assess the type of visual disorder the first time, allowing physicians to prescribe the right treatment and reduce costs of retesting and misdiagnosis,” he said.
Amblyopia is estimated to present in 1% to 4% of children in the United States. However, currently only 21% of preschool-aged children are screened for this condition. Children in public school are tested for amblyopia between the ages of 7 and 8. According to the American Academy of Pediatrics, testing should occur sooner.
“By screening children sooner … we will catch amblyopia or another treatable disorder that would otherwise deteriorate vision over time, ” Mr. Joish said.
Photoscreening advantage
In the study, Mr. Joish and fellow researchers Daniel C. Malone, PhD, and Joseph Miller, MD, MPH, analyzed vision tests from three age groups: 6- to 18-month-olds, 3- to 4-year-olds and 7- to 8-year-olds.
“The screening measures we evaluated for the visual acuity screening involved a combination of charts, symbols and ‘E’ letter games,” Mr. Joish said. The tests require full attention and compliance from the child, which can be difficult, he added.
“It’s hard to get toddlers, children who are preverbal and those who have developmental problems to easily cooperate or verbalize their responses. This is why we hypothesized that photoscreening tests would have a greater benefit,” he said.
Testing preschool-aged children with a photoscreener — a camera that detects the presence of a visual defect by photo refraction — requires little cooperation from the child, unlike the traditional VAS tests, which demand full cooperation, he said. With photoscreening, children just have to be still long enough to have their “picture” taken by the camera.
“Photoscreening represents a simpler task for the child. Therefore, the results obtained can be more reliable, more sensitive and more specific than the traditional visual acuity screenings,” Mr. Joish said.
Additionally, photoscreening provides documentation that can be reviewed and interpreted by multiple individuals, while VAS tests do not provide tangible results.
Analysis model
In the study, researchers took the data from these tests and incorporated it into a decision software program to produce a formal benefit-to-cost analysis. The analysis assessed which test would be most beneficial with regard to cost, Mr. Joish said.
“The costs and probabilities came from two main sources. We looked at the literature available on costs for management of patients with visual disorders, along with HMO claims and service codes,” he said.
In order to estimate the monitoring cost of vision loss in children with untreatable or undetected amblyopia, researchers assumed vision loss would be bilateral for life. For these patients, they calculated the disability payment allotted by the Social Security Administration for a legally blind person.
“We integrated the allowance given by the government into our computer formula. Payments totaled $6,372 annually,” Mr. Joish said.
High benefits
After entering the costs and probabilities of events into the decision software, researchers found that the cost-to-benefit ratios of both the PS and the VAS tests exceeded 1.00.
“This means that all the screening programs studied were beneficial. Also, the benefits exceeded the cost of screening,” Mr. Joish said. The average cost for screening a child with a photoscreener was $134, he said.
However, the test and age group that reaped the highest benefit was the PS test in the 3- to 4-year-old age group. The sensitivity of the PS camera was the most influential variable in determining the most cost-beneficial program, Mr. Joish said.
“The net benefit was highest for toddlers, who saved the government $35,597 in their lifetimes, as opposed to children who took visual acuity screening tests at age 7 or 8. This age group saved the government just $27,831,” Mr. Joish said.
Additionally, the 3- to 4-year-old age group surpassed all other age groups in the VAS benefit-to-cost ratio.
“This seems to be the best age to catch sight-threatening illnesses on an economical level, as well as a health concern level,” Mr. Joish said.
Study limitations
While results were favorable toward photoscreening preschoolers, physicians must be aware of two major limitations in this study that may hinder conclusive evidence, Mr. Joish said.
“As you know, the loss of vision due to amblyopia is usually unilateral. In this study we had to assume patients would have bilateral vision loss, because of the difficulty of placing a monetary value on lifetime unilateral vision loss,” Mr. Joish explained.
However, the order of these results remained robust over a wide range of costs. Thus, confidence should be placed on the order of these study results rather than the magnitude, Mr. Joish said.
The additional assumption made by study researchers was the compliance rate among children undergoing the visual acuity tests.
“We assumed participation rates and compliance rates among children would be 100%. Unfortunately, in real life, this might not always be the case,” Mr. Joish said.
For Your Information
- Vijay N. Joish, MS, can be reached at the University of Arizona College of Pharmacy, P.O. Box 210207, 1703 E. Mabel St., Tucson, AZ 85721; (520) 626-4452; fax: (520) 626-7355; e-mail: joish@pharmacy.arizona.edu.