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Economic Evaluation of Orthoptic Screening: Results of a Field Study in 121 German Kindergartens

¹ From the Department of Health Economics, University of Ulm, Ulm, Germany; and the ² Department of Ophthalmology II, University Eye Hospital Tübingen, Tübingen, Germany.

PURPOSE. The purpose of this study was to analyze the cost-effectiveness of an orthoptic screening program in kindergarten children.

METHODS. An empiric cost-effectiveness analysis was conducted as part of a field study of orthoptic screening. Three-year-old children (n = 1180) in 121 German kindergartens were screened by orthoptists. The number of newly diagnosed cases of amblyopia and amblyogenic factors (target conditions) was used as the measure of effectiveness. The direct costs of orthoptic screening were calculated from a third-party-payer perspective based on comprehensive measurement of working hours and material costs.

RESULTS. The average cost of a single orthoptic screening examination was 12.58 Euro. This amount consisted of labor costs (10.99 Euro) and costs of materials and traveling (1.60 Euro). With 9.9 children screened on average per kindergarten, average labor time was 279 minutes per kindergarten, or 28 minutes per child. It consisted of time for organization (46%), traveling (16%), preparing the examination site (10%), and the orthoptic examination itself (28%). The total cost of the screening program in all 121 kindergartens (including ophthalmic examination, if required) was 21,253 Euro. Twenty-three new cases of the target conditions were detected. The cost-effectiveness ratio was 924 Euro per detected case. Sensitivity analysis showed that the prevalence and the specificity of orthoptic screening had substantial influence on the cost-effectiveness ratio.

CONCLUSIONS. The data on the cost-effectiveness of orthoptic screening in kindergarten may be used by such third-party payers as health insurance or public health services when deciding about organizing and financing preschool vision-screening programs.

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