Cost–Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil
Cost–Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil
Data
2021
Autores
Neves, Luiza M.
Haefeli, Lorena M.
Zin, Andrea A.
Steffen, Ricardo E.
Vasconcelos, Zilton F. M.
Pinto, Márcia
Journal Title
Journal ISSN
Volume Title
Publisher
Frontiers in Pediatrics
Resumo
Purpose: To evaluate the cost–utility of wide-field imaging (WFI) as a complementary
technology for retinopathy of prematurity (ROP) screening from the Brazilian Unified
Health System’s perspective.
Introduction: ROP is one of the leading causes of avoidable childhood blindness
worldwide, especially in middle-income countries. The current ROP screening involves
indirect binocular ophthalmoscopy (IBO) by ROP expert ophthalmologists. However,
there is still insufficient ROP screening coverage. An alternative screening strategy is
the combination of WFI with IBO.
Methods: A cost–utility analysis was performed using a deterministic decision-tree
simulation model to estimate incremental cost–utility for ROP care. Two screening
strategies were compared: (1) IBO and (2) combination of WFI of all eligible preterm
infants and IBO for type 2 ROP or worse and for non-readable images. Eligible population
included preterm infants <32 weeks of gestational age or birth weight equal to or
<1,500 g. The temporal horizon was lifetime. Visual outcome data was converted to
utility, and the health benefits were estimated on quality-adjusted life-years (QALY).
Incremental cost per QALY gained was calculated from the health system perspective.
Costs were estimated considering equipment, maintenance, consumables, and staff.
A micro-costing approach was used for WFI. Two technician nurses were trained for
imaging execution and had their time evaluated. Two ROP expert ophthalmologists had
their time evaluated for imaging reading. One-way sensitivity analysis and probabilistic
sensitivity analysis were performed.
Results: Combined screening strategy resulted in a cost-effective program considering
90% ROP screening coverage. Costs per examination: (1) screening with IBO: US
dollar (US $) 34.36; (2) screening with combination: US $58.20; (3) laser treatment:
US $642.09; (4) long-term follow-up: ranged from US $69.33 to 286.91, based on the
infant’s visual function. Incremental cost per QALY gained was US $1,746.99/QALY per
infant screened with the combination strategy. One-way sensitivity analysis resulted in
cost-effectiveness for all parameters. Probabilistic sensitivity analyses yielded a 100%
probability of combination being cost-effective in a willingness-to-pay threshold of
US $1,800/QALY.
Conclusion: The combined strategy for ROP screening was cost-effective. It enhances
access for appropriate ROP care in middle-income countries and dminishes opportunity
costs for ophthalmologists.
Description
Palavras-chave
retinopathy of prematurity, neonatal screening, diagnosis, healthcare economics, costs and cost analysis, quality-adjusted life years (QALY), telemedicine, Brazil
Citação
Neves LM, Haefeli LM, Zin AA, Steffen RE, Vasconcelos ZFM, Pinto M. Cost-Utility Analysis of Wide-Field Imaging as an Auxiliary Technology for Retinopathy of Prematurity Care in Brazil. Front Pediatr. 2021 Dec 16;9:757258. doi: 10.3389/fped.2021.757258.