Costs associated with retinopathy of prematurity: a systematic review and meta-analysis

Abstract

Objectives: To review and analyse evidence regarding costs for retinopathy of prematurity (ROP) screening, lifetime costs and resource use among infants born preterm who develop ROP, and how these costs have developed over time in different regions.

Design: Systematic review and meta-analysis DATA SOURCES: PubMed and Scopus from inception to 23 June 2021.

Eligibility criteria for selecting studies: Included studies presented costs for ROP screening and the lifetime costs (including laser treatment and follow-up costs) and resource use among people who develop ROP. Studies not reporting on cost calculation methods or ROP-specific costs were excluded.

Data extraction and synthesis: Two independent reviewers screened for inclusion and extracted data, including items from a published checklist for quality assessment used for bias assessment, summary and random-effects meta-analysis for treatment costs. Included studies were further searched to identify eligible references and citations.

Results: In total, 15 studies reported ROP screening costs, and 13 reported lifetime costs (either treatment and/or follow-up costs) for infants with ROP. The range for screening costs (10 studies) was US$5-US$253 per visit, or US$324-US$1072 per screened child (5 studies). Costs for treatment (11 studies) ranged from US$38 to US$6500 per child. Four studies reported healthcare follow-up costs (lifetime costs ranging from US$64 to US$2420, and 10-year costs of US$1695, respectively), and of these, three also reported lifetime costs for blindness (range US$26 686-US$224 295) using secondary cost data. Included papers largely followed the quality assessment checklist items, thus indicating a low risk of bias.

Conclusion: The costs of screening for and treating ROP are small compared with the societal costs of resulting blindness. However, little evidence is available for predicting the effects of changes in patient population, screening schedule or ROP treatments.

Prospero registration number: CRD42020208213.

Keywords: health economics; medical retina; paediatric ophthalmology.

Figure 1

Map of data availability and costs per (A) screening visit and (B) treatment. The map illustrates reported costs or means of reported costs per country for included studies in US$. In studies presenting only total screening cost per infant or by first/follow-up visits, the cost level per screening was calculated under the assumption of four screening visits per infant. Where only screening cost per eye was reported, it was duplicated to obtain the cost level per screening. In studies reporting only unit cost per treatment, the unit cost was assumed to indicate the cost level of treatment per infant. where costs were reported separately for unilateral and bilateral treatment, a weighted mean cost was calculated assuming that 75% of treatments were bilateral.

Figure 2

Forest plot of treatment costs, by country categorisation. In parentheses, ER of included studies: 1=for example, properly powered randomised controlled trials; 2=for example, prospective cohort studies; 3=for example, retrospective cohort studies; 4=case series with or without intervention or cross-sectional study; 5=for example, opinion of respected authorities. Country abbreviated according to ISO code. ER, evidence rating; REML, restricted maximum likelihood.

Figure 3

Forest plot of treatment costs, cumulative results by year and country categorisation. in parentheses, ER of included studies: 1=for example, properly powered randomised controlled trials; 2=for example, prospective cohort studies; 3=for example, retrospective cohort studies; 4=case series with or without intervention or cross-sectional study; 5=for example, opinion of respected authorities. Country abbreviated according to ISO code. ER, evidence rating; REML, restricted maximum likelihood.