Javitt J, Dei Cas R, Chiang Y P
Worthen Center for Eye Care Research, Georgetown University Medical Center, Washington, DC 20007.
Pediatrics. 1993 May;91(5):859-66.
Retinopathy of prematurity (ROP) is the leading cause of blindness among premature infants. A recent National Eye Institute-sponsored prospective, multicenter trial investigating the use of cryotherapy for treatment of ROP demonstrates a significant reduction in blindness and low vision for patients with sight-threatening (stage 3+) ROP.
A microsimulation model is presented to determine the cost-effectiveness of cryotherapy for ROP. Simulations are performed for three subpopulations of premature infants with birth weights 500 through 749 g, 750 through 999 g, and 1000 through 1249 g, and for three screening strategies--weekly, biweekly, and monthly.
Appropriately timed screening for and treatment of ROP is predicted to result in a gain of 3899 to 4648 quality-adjusted-life-years and a net governmental budgetary savings of $38.3 to $64.9 million for each annual US birth cohort of 28,321 premature infants (500 through 1249 g). The cost per quality-adjusted-life-year gained is $2488 to $6045, depending on different screening strategies.
Of greatest importance is the finding that properly timed screening and treatment for ROP is not only cost saving but may save approximately 320 infants per year from a lifetime of blindness.
早产儿视网膜病变（ROP）是早产婴儿失明的主要原因。美国国立眼科研究所近期发起了一项前瞻性多中心试验，研究冷冻疗法治疗ROP的效果，结果显示，对于有视力威胁（3期及以上）的ROP患者，失明和视力低下的情况显著减少。
本文提出了一个微观模拟模型，以确定冷冻疗法治疗ROP的成本效益。针对出生体重在500至749克、750至999克、1000至1249克的三个早产儿亚组，以及每周、每两周和每月三种筛查策略进行了模拟。
预计对ROP进行适时筛查和治疗，对于美国每年出生的28321名早产儿（500至1249克）的每个出生队列，将带来3899至4648个质量调整生命年的收益，政府预算净节省3830万至6490万美元。根据不同的筛查策略，每获得一个质量调整生命年的成本为2488至6045美元。
最重要的发现是，对ROP进行适时筛查和治疗不仅节省成本，而且每年可能使约320名婴儿免于终身失明。
