基于家庭的弱视筛查系统的验证和成本效益分析。

Validation and cost-effectiveness of a home-based screening system for amblyopia.

机构信息

State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong Province, China.

出版信息

Ophthalmology. 2012 Jun;119(6):1265-71. doi: 10.1016/j.ophtha.2011.12.027. Epub 2012 Feb 23.

DOI:10.1016/j.ophtha.2011.12.027

PMID:22365057

Abstract

PURPOSE

To investigate the cost-effectiveness of a novel home-based screening system for amblyopia and amblyogenic risk factors.

DESIGN

Evaluation of diagnostic test or technology.

PARTICIPANTS

Two thousand four hundred forty-two preschoolers 3 to 6 years of age from 10 kindergartens randomly selected from Guangzhou participated in the study in 2009.

METHODS

Preschoolers were assessed for amblyopia and amblyogenic risk factors by their parents using the home-based screening system and were re-evaluated by professionals who conducted a comprehensive eye examination.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive predictive value, negative predictive value, and the cost-benefit of the home-based screening system were calculated by comparing the results from the home-assessed model and those from the professional evaluation.

RESULTS

Three thousand three hundred children were invited to participate in the study, and 2308 (1216 boys and 1092 girls) completed all of the procedures. Twenty-four amblyopes were found by professional examinations. Fifteen of these amblyopes had not been diagnosed previously, and 12 of them were detected by the home-assessment model. The sensitivity, specificity, positive predictive value, and negative predictive value were 80.0%, 94.1%, 8.2%, and 99.9%, respectively. Professional examinations cost an average of US $1131.00 per case of amblyopia detected, whereas the cost was only US $266.00 per case for the home-based method. For amblyogenic factors, 50, 87, and 96 children were classified into grade I, II, or III according to the professional examinations. The corresponding numbers in the home-based system were 23, 29, and 15, respectively. Accordingly, the true positive rates were 46.0%, 33.3%, and 15.6% for each grade.

CONCLUSIONS

The home-based amblyopia screening system was found to be a simple, effective, and cost-beneficial method for amblyopia screening and amblyogenic risk factors. The approach offers a practical option for developing areas with large populations.

FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

摘要

目的

研究一种新型家庭弱视及弱视危险因素筛查系统的成本效益。

设计

诊断测试或技术的评估。

参与者

2009 年，从广州的 10 所幼儿园中随机抽取 2442 名 3 至 6 岁的学龄前儿童参与了这项研究。

方法

家长使用家庭筛查系统对学龄前儿童进行弱视和弱视危险因素评估，专业人员进行全面眼科检查进行复查。

主要观察指标

通过比较家庭评估模型和专业评估结果，计算家庭筛查系统的敏感性、特异性、阳性预测值、阴性预测值和成本效益。

结果

共邀请了 3300 名儿童参加研究，其中 2308 名（1216 名男孩和 1092 名女孩）完成了所有程序。专业检查发现 24 名弱视儿童。其中 15 例之前未确诊，12 例由家庭评估模型检出。敏感性、特异性、阳性预测值和阴性预测值分别为 80.0%、94.1%、8.2%和 99.9%。专业检查每检出一例弱视的平均费用为 1131.00 美元，而家庭方法的费用仅为 266.00 美元。对于弱视危险因素，根据专业检查，50、87 和 96 名儿童被分为 I、II 或 III 级。家庭系统中相应的数字分别为 23、29 和 15。因此，各级的真阳性率分别为 46.0%、33.3%和 15.6%。