Bennett Hayley, Britton Andy, O'Sullivan David, Lado Francesca
Health Technology Wales, Cardiff, Wales.
Optometry Wales, Haverfordwest, Wales.
Cost Eff Resour Alloc. 2025 Jun 4;23(1):26. doi: 10.1186/s12962-025-00632-w.
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.
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).
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.
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.
早期干预以减缓儿童近视进展可能会改善生活质量，并预防未来给个人和医疗保健系统带来负担的并发症。本研究评估了近视控制眼镜和隐形眼镜在威尔士儿童及青少年中减缓近视进展的成本效益。
一项成本效用分析将周边离焦眼镜（PPSL）、多焦点软性隐形眼镜（MFSCL）和角膜塑形术与单焦点矫正进行了比较。疗效和安全性参考了Cochrane系统评价和荟萃分析。威尔士国民保健服务体系（NHS Wales）产生的质量调整生命年（QALYs）和成本在整个生命周期内进行建模，并按3.5%的贴现率贴现。敏感性分析估计了增量成本效益比（ICER）的不确定性。
据估计，PPSL带来的益处极小，且成本高于单焦点矫正。MFSCL可使QALY提高0.28，额外成本为4040英镑；与单焦点矫正相比，对应的ICER为8367英镑。角膜塑形术可使QALY提高0.5，额外成本为3732英镑；与单焦点矫正相比，对应的ICER为3995英镑。在概率敏感性分析中，MFSCL和角膜塑形术的ICER分别在71%和90%的模拟中低于20000英镑。在76%的模拟中，角膜塑形术是最具成本效益的策略。成本效益受进展率变化、干预成本和高度近视效用的影响。然而，角膜塑形术始终是最具成本效益的策略。
在英国采用的阈值下，MFSCL和角膜塑形术可能是减缓近视进展的具有成本效益的选择。需要进一步研究以了解近视控制干预措施的长期影响及其对生活质量的影响。
