Cost-effectiveness analysis of vision screening program in schools under Bangkok metropolitan authority

Abstract

This study is to evaluate the sensitivity and the specificity of the school vision screening tests, the referral compliance rate and associate factors, and to evaluate the cost-effectiveness of the school vision screening program. The sutdy compares the cost-effectiveness ratios of school vision screening program among 4 alternatives. The alternatives are: alternative 1) vision screening using visual acuity test and stereopsis test and provision of eye care by mobile teams; alternative 2) vision screening using visual acuity test and provision of mobile team; alternative 3) vision screening using visual acuity test and stereopsis test and detected cases refer to existing health care faclities; and alternative 4) vision screening using visual acuity test and detected cases refer to existing health care facilities. The results of this study are as follow: the sensitivity of the VA test plus stereopsis test is 75%, which is higher than the sensitivity of the VA test alone (68%); the specificity ofcombined tests and VA test alone are nearly equal (95.8% and 96.6%) The overall referral compliance rate is 82%. Factors associated with compliance are family income, mothers' education level and the referral cost. The overall referral compliance rate is 82%. Factors associated with compliance are family income, mothers' education level and the referral cost. The cost-effectiveness ratios of alternative 1 to alternative 4 are: 1,877.34; 1,823.47; 1,823.09 and 1,788.11 Baht per case, reapectively. The combined screening test (VA plus stereopsis test) results in smaller number of false negative cases (false negative rate 0.47 cases per 1,000 students) compares to that of the VA test alone (10.84 cases per 1,000 students). With all the findings it can be concluded that the best alternative for the school vision screening program is the alternative using combined screening tests and refer, which results in small CER and less false negative. In conclusion, it could be recommended that the school vision screening is a cost-effective health preventive program and should be performed in other provinces. The referral compliance is crucial for the success of the program.