Cost and quality of life of overlooked eye care needs of children

Monali S Malvankar-Mehta,1,2 Ryan Wilson,3 Erik Leci,3 Kelly Hatch,4 Sapna Sharan1 1Department of Ophthalmology, Ivey Eye Institute, St. Joseph’s Hospital, 2Department of Epidemiology and Biostatistics, 3Schulich School of Medicine and Dentistry, 4Allyn & Betty Taylor Library, Natural Sciences Centre, The University of Western Ontario, London, ON, Canada Background: The objective of this research was to conduct a systematic review and cost analysis to summarize, from the Ministry of Health perspective, the costs families might incur because of their child’s prescription for refractive errors and amblyopia correction.Methods: Databases including MEDLINE, Embase, BIOSIS, CINAHL, HEED, ISI Web of Science, and the Cochrane Library as well as the gray literature were searched. Systematic review was conducted using EPPI-Reviewer 4. Percentage difference in cost of glasses and patches per patient per various diagnoses were computed. The cost of glasses and patches was projected over a 5-year time horizon. Cost-utility analysis was performed.Results: In total, 302 records were retrieved from multiple databases and an additional 48 records were identified through gray literature search. From these, a total of 14 studies (10,388 subjects) were eligible for quantitative analysis. The cost of glasses increased significantly for congenital cataract patients to US$1,820, esotropia patients to US$840, myopes to US$411, amblyopes (mixed) to US$916, anisometropes to US$521, and patients with strabismus to US$728 over a 5-year period making them unaffordable for low-income families. Incremental cost of glasses of congenital cataract patients with delayed treatment was computed to be US$1,690 per health utility gained. Incremental cost of glasses for high refractive error was US$93 per health utility gained in non-compliant children. For amblyopia patients, incremental cost of glasses per quality-adjusted life years gained was US$3,638.Conclusion: Cost of corrective lenses is associated with significant financial burden and thus other means of mitigating costs should be considered. Eyesight problems in children are perceived as low-priority health needs. Thus, educational interventions on substantial visual deficits of not wearing glasses should be offered to families and governmental health agencies. Keywords: systematic review, amblyopia, prescription lens, utility, cost, quality-adjusted life year

The value of corneoscleral rim cultures in keratoplasty: a systematic review and cost-effectiveness analysis

Efstathia Kiatos,1 James J Armstrong,2,3 Cindy ML Hutnik,3,4 Stephen M Tsioros,5 Monali S Malvankar-Mehta,1,4 William G Hodge1,4 1Department of Epidemiology and Biostatistics, 2Department of Pathology, 3Department of Ophthalmology, Schulich School of Medicine and Dentistry, Western University, 4Department of Ophthalmology, Ivey Eye Institute, St Joseph’s Health Care London, 5Department of Kinesiology, Western University, London, ON, Canada Purpose: This study evaluated the performance of donor corneoscleral rim cultures for predicting infection after corneal transplantation, and determines if there is a correlation between positive corneoscleral rim cultures and postkeratoplasty infection.Design and data sources: This was a systematic review, prognostic accuracy analysis, and cost-effectiveness analysis. Databases searched were: Medline (Ovid), Embase (Ovid), CINAHL, Cochrane Library, Web of Science, and BioSis Previews. Grey literature was also explored.Materials and methods: A systematic review was conducted to locate published and unpublished studies. All studies examining corneal button contamination and its association with endophthalmitis and keratitis posttransplantation were included. Extracted data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value. Cost data from the London Laboratory Services Group in London, ON were used to calculate the cost-effectiveness of culturing donor rim cultures.Results: Of 7,870 grafts, 954 had a positive rim culture (12.1%), with 12 patients going on to develop keratitis or endophthalmitis (1.3%). The prevalence of keratitis and endophthalmitis in this study was 0.15%, and the positive predictive value 1.5%. Of the 12 infections, nine were fungal and three bacterial. The estimated cost of a positive and negative test result was CAD$45.99 and$14.15, respectively. The cost to run all 7,870 tests was estimated to be $141,735.86, with an incremental cost-effectiveness ratio of$40,215.70.Conclusion: There was a significant divergence between bacterial and fungal rim-culture results. Bacterial cultures predicted clinical infection poorly, did not change management, and were expensive. Fungal cultures predicted clinical infection in over 10% of patients, had the potential to change management, and were 40% less expensive than full rim culturing (bacterial and fungal tests). Fungal rim cultures may be considered in areas where fungal infection rates are high. Keywords: corneoscleral rim cultures, eye infection, keratoplasty, culture techniques&nbsp