Lifetime cost-effectiveness of myopia control intervention for the children population

Abstract

Background: Myopia is a common eye condition and projected to affect half of the global population by 2050. Controlling its progression during childhood may prevent associated ocular diseases in later life. Certain interventions retard myopia progression but their long-term costs and consequences are not well understood. We evaluated the cost-effectiveness of myopia control via an optical approach using the Defocus Incorporated Multiple Segments (DIMS) lens over a lifetime.

Methods: We constructed an individual-based, state-transition model to simulate 1) the development and progression of myopia in childhood with and without control and 2) the impact of myopia on the development of four sight-threatening complications in adulthood. We compared strategies of myopia control with 100% uptake vs. no myopia control from the societal perspective to determine whether myopia control is value for money.

Results: With myopia control, the cumulative prevalence of high myopia was relatively reduced by 44.7% (5.9 vs. 10.7%) and severe visual impairment by 19.2% (2.2 vs. 2.7%) compared to no myopia control. The lifetime cost per quality-adjusted life year gained was 26 407 US dollars (USD) and is considered cost-effective compared to the threshold recommended by the World Health Organization (WHO) of one times annual per capita gross domestic product (48 359 USD). Probabilistic sensitivity analysis showed that myopia control had an 87% likelihood of being cost-effective at the WHO threshold.

Conclusions: Myopia control is cost-effective when provided to all eligible children. Further investigation is required to determine if it is cost-effective for the government to subsidise myopia control in order to maximise access.

Figure 1

Simulation of natural progression of myopia and related ocular complications. D – dioptre, VA – visual acuity.

Figure 2

Tornado chart for one-way sensitivity analysis of myopia control using DIMS compared with no myopia control. Black bars represent the ICERs when parameter value changed to the upper bound, white bars represent the ICERs when parameter value changed to the lower bound. DIMS – Defocus Incorporated Multiple Segments, MMD – myopic macular degeneration, NC – nuclear cataract, OAG – open angle glaucoma, PSC – posterior subcapsular cataract, QALY – quality-adjusted life year, RD – retinal detachment, VI – visual impairment.

Figure 3

Cost-effectiveness acceptability curve of myopia control using DIMS compared with no myopia control. DIMS – Defocus Incorporated Multiple Segments, QALY – quality-adjusted life year, WTP – willingness-to-pay.