Cost-effectiveness of screening for amblyopia

Background: The effectiveness of a screening program for amblyopia has been discussed controversely for several years. While the medical profit is obvious, little is known on the cost-effectiveness of such a screening program. Methods: By literature research all important variables were determined: incidence of amblyopia, sensitivity of different screening modalities, effectiveness of therapy, costs as well as the loss of utility and life quality by an existing amblyopia. Based on those data in a simple model the costs of a screening program for amblyopia were determined per quality adjusted life year (QALY). The result was analyzed for its stability by sensitivity analysis and compared to the costs of other therapies. Results: Amblyopia occurs with an incidence of approximately 2% (1.3-12%). Most Screening programs reach a sensitivity of 60-90% and cause costs of 9001400 Euro per detected case. By appropriate therapy with mean costs of 2300 Euro approx. 60% of the cases obtain useful vision of > 20/40. However, therapy results vary considerably. After discounting the incremental cost-effectiveness ratio (ICER) reaches 7684 Euro/QALY for a screening and treatment program for amblyopia. This is well comparable with other therapies and accepted to be cost-efficient. Sensitivity analysis yielded 24700 Euro/QALY and 57633 Euro/QAL with higher discounting for worst case scenarios. Conclusion: Screening for amblyopia meets the basic requirements of cost-effectiveness.