The Economic Model of Retinopathy of Prematurity (EcROP) Screening and Treatment: Mexico and the United States

doi:10.1016/j.ajo.2016.04.014

American Journal of Ophthalmology

Volume 168, August 2016, Pages 110-121

https://doi.org/10.1016/j.ajo.2016.04.014 Get rights and content

Purpose

To describe an economic (Ec) model for estimating the impact of screening and treatment for retinopathy of prematurity (ROP).

Design

EcROP is a cost-effectiveness, cost-utility, and cost-benefit analysis.

Methods

We surveyed caregivers of 52 children at schools for the blind or pediatric eye clinics in Atlanta, Georgia and 43 in Mexico City. A decision analytic model with sensitivity analysis determined the incremental cost-effectiveness (primary outcome) and incremental monetary benefit (secondary outcome) of an ideal (100% screening) national ROP program as compared to estimates of current practice. Direct costs included screening and treatment expenditures. Indirect costs estimated lost productivity of caretaker(s) and blind individuals as determined by face-to-face surveys. Utility and effectiveness were measured in quality-adjusted life years and benefit in US dollars. EcROP includes a sensitivity analysis to assesses the incremental cost-effectiveness and societal impact of ROP screening and treatment within a country or economic region. Estimates are based on evidence-based clinical data and region-specific economic data acquired from direct field survey.

Results

In both Mexico and the United States, an ideal national ROP screening and treatment program was highly cost-saving. The incremental net benefit of an ideal ROP program over current practice is $5556 per child ($206 574 333 annually) and $3628 per child ($205 906 959 annually) in Mexico and the United States, respectively.

Conclusion

EcROP demonstrates that ROP screening and treatment is highly beneficial for quality of life, cost saving, and cost-effectiveness in the United States and Mexico. EcROP can be applied to any country or region to provide data for informed allocation of limited health care resources.

Section snippets

Methods

We performed a cost-utility and cost-benefit analysis for implementation of an ideal ROP screening and treatment program in both the United States and Mexico. We incorporated sensitivity analysis and measured for the relative impact of this intervention by using commonly accepted parameters for cost-effectiveness.

In addition to using published data, EcROP gathered country-specific economic data using local care standard-of-care clinical protocols combined with economic data from face-to-face

Results

We report the results in 2014 US dollars, discounted at 3%. Labor and caregiver data are gender adjusted when possible. The base case analysis of our model revealed that ideal national screening and treatment programs in Mexico and the United States would be extremely cost-effective and have a substantially greater net monetary benefit when compared to current practice (Table 2). The ICER of a national program over current practice calculates to a negative value for both Mexico and the United

Discussion

The EcROP model analyzes the economic impact of ROP screening and treatment at a national and societal level for the designated country or economic region. The EcROP face-to-face interviews and fieldwork gathered relevant data and included a sensitivity analysis that provides socioeconomic information about both direct and indirect cost data for the regions studied. Information from both the United States (an example of a developed nation) and Mexico (an example of a middle-income developing

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We believe that a physician input is necessary as a fail-safe mechanism. Failing to address these issues may result in severe disease being missed, which invariably leads to blindness for the child (CRYO-ROP, 2001), and impact in terms of quality of life (ROTHSCHILD; RUSS; BRENNAN et al., 2016). As with telemedicine and screening in general, the attending physician may also be exposed to medicolegal implications if severe disease is missed. (
The incidence of retinopathy of prematurity (ROP) continues to rise due to the improved survival of very low birth weight infants in developed countries. This epidemic is also fueled by increased survival of preterm babies with variable use of oxygen and a lack of ROP awareness and screening services in resource-limited regions. Improvements in technology and a basic understanding of the disease pathophysiology have changed the way we screen and manage ROP, educate providers and patients, and improve ROP awareness. Advancements in imaging techniques, expansion of telemedicine services, and the potential for artificial intelligence-assisted ROP screening programs have created opportunities to improve ROP care in areas with a shortage of ophthalmologists trained in ROP. To address the gap in provider knowledge regarding ROP, the Global Education Network for Retinopathy of Prematurity (GEN-ROP) created a web-based tele-education training module that can be used to educate all providers involved in ROP, including non-physician ROP screeners. Over the past 50 years, the treatment of severe ROP has evolved from limited treatment modalities to cryotherapy and laser photocoagulation. More recently, there has been growing evidence to support the use of anti-vascular endothelial growth factor (VEGF) agents for the treatment of severe ROP. However, VEGF is known to be important in organogenesis and microvascular maintenance, and given that intravitreal anti-VEGF treatment can result in systemic VEGF suppression over a period of at least 1–12 weeks, there are concerns regarding adverse effects and long-term ocular and systemic developmental consequences of anti-VEGF therapy.
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ROP is one of the leading causes of childhood blindness worldwide and is currently estimated to cause 20,000 cases of blindness or severe visual impairment per annum1. ROP is a lifetime disease with significant deleterious role on other ocular diseases (glaucoma, amblyopia, strabismus, myopia, retinal detachment) and huge financial and emotional burdens to families and societies.2 The two determinant factors for ROP are immature retinal vessels due to prematurity and oxygen therapy causing oxidative injury (Fig. 1); and their interactions are influenced by several factors including oxidative distress, intermittent hypoxia (IH), inflammation, dysregulated growth factors such as vascular endothelial growth factor (VEGF) and many other factors that contribute to ROP risk and severity.3
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Original articleThe Economic Model of Retinopathy of Prematurity (EcROP) Screening and Treatment: Mexico and the United States

Purpose

Design

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Early Hum Dev

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

J AAPOS

Mechanisms and management of retinopathy of prematurity

N Engl J Med

The incidence and course of retinopathy of prematurity: findings from the Early Treatment for Retinopathy of Prematurity Study

Pediatrics

American Academy of Ophthalmology: American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity

Pediatrics

Manejo de la retinopatia del recien nacido prematuro

National Neonatology Forum of India (NNF) Clinical Practice Guidelines: Retinopathy of Prematurity

Beyond newborn survival paper 3. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010

Pediatr Res

Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs

Pediatrics

Very-low-birth-weight infant outcomes in 11 South American NICUS

J Perinatol

Retinopathy of prematurity screening and treatment cost in Brazil

Rev Panam Salud Publica

Human Development Report, 2015

Multicenter trial of cryotherapy for retinopathy of prematurity: ophthalmological outcomes at 10 years

Arch Ophthalmol

Recommendations for reporting cost-effectiveness analyses. Panel on Cost-Effectiveness in Health and Medicine

JAMA

Original article
The Economic Model of Retinopathy of Prematurity (EcROP) Screening and Treatment: Mexico and the United States