Cost-effectiveness of myopia-control spectacles and contact lenses for children and adolescents in Wales

Abstract

Background: Early intervention to slow childhood progression of myopia may improve quality of life and prevent future complications that burden individuals and healthcare systems. This study assessed the cost-effectiveness of myopia-control spectacles and contact lenses for the reduction of myopia progression among children and adolescents in Wales. Methods: A cost-utility analysis compared peripheral plus spectacle lenses (PPSL), multifocal soft contact lenses (MFSCL) and orthokeratology against single-vision correction. Efficacy and safety were informed by a Cochrane systemic review and meta-analyses. Quality-adjusted life years (QALYs) and costs incurred by NHS Wales were modelled over a lifetime horizon and discounted at 3.5%. Sensitivity analyses estimated uncertainty in incremental cost-effectiveness ratios (ICERs). Results: PPSL was estimated to provide minimal benefit at a higher cost than single-vision correction. MFSCL gave a 0.28 QALY improvement at an additional cost of £4,040; corresponding to an ICER of £8,367 versus single-vision correction. Orthokeratology provided 0.5 QALYs at an additional cost of £3,732; corresponding to an ICER of £3,995 versus single-vision correction. In probabilistic sensitivity analysis, ICERs were below £20,000 in 71% and 90% of simulations for MFSCL and orthokeratology, respectively. Orthokeratology was the most cost-effective strategy in 76% of simulations. Cost-effectiveness was influenced by changes in progression rates, intervention costs and the utility of high myopia. However, orthokeratology remained the most cost-effective strategy throughout. Conclusions: MFSCL and orthokeratology may be cost-effective options to slow the progression of myopia at thresholds applied in the UK. Further research is needed to understand the long-term effects of myopia-control interventions and their impact on quality of life.