A cost-benefit analysis of vision screening methods for preschoolers and school-age children

J AAPOS. 2003 Aug;7(4):283-90. doi: 10.1016/s1091-8531(03)00116-2.


Introduction: The purpose of this study was to determine costs and benefits of visual acuity screening (VAS) or photoscreening (PS) in children.

Methods: A societal-perspective, decision-analytic model compared VAS and PS conducted in three age groups: children 6 to 18 months, 3 to 4 years, and 7 to 8 years old. Literature estimates of sensitivity, specificity, and prevalence were used. Cost estimates and referral rates for surgical treatment were derived from a managed care database and the United States Social Security Administration.

Results: All the benefit-to-cost ratios exceeded 1.0, meaning that all screening programs studied had benefits that exceeded the cost of screening. The total net benefit was highest for PS in children of 3 to 4 years of age (19,412 US dollars) and the least for VAS in children 7 to 8 years of age (15,179 US dollars). The benefit-to-cost ratio was highest for the VAS in children 3 to 4 years of age (162 US dollars) and least for PS in infants 6 to 18 month old (140 US dollars). Sensitivity of the PS instrument and VAS charts were the most influential variables in determining the most cost-beneficial program.

Conclusions: Based on the best available data, the net benefit of PS in 3 to 4 year old preschool children is greater than VAS in children 7 to 8 years of age, PS in toddlers, and VAS in children 3 to 4 years of age.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Child
  • Child, Preschool
  • Cost-Benefit Analysis
  • Humans
  • Infant
  • Models, Economic*
  • Sensitivity and Specificity
  • United States
  • Vision Disorders / diagnosis*
  • Vision Disorders / economics
  • Vision Screening / economics*
  • Vision Screening / methods
  • Visual Acuity