Journal of global health · 2025
Economic evaluation, resource utilisation, and associated economic burden of myopia management: a systematic literature review.
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de Milliano Thom Wl, Shi-van Wielink Kun, Ernst Frederic, Mulkalapalli Nagarjuna, Pagidigummula Ravali, Lymperopoulou Christina
Аннотация
BACKGROUND: Myopia progression through childhood to early adulthood can cause serious visual complications and impose a significant economic impact due to its high prevalence and associated management costs. This systematic literature review evaluates the economic impact, health care resource utilisation (HCRU), and cost-effectiveness of current myopia interventions.
METHODS: The systematic literature review was performed via the OVID SP® platform (software version 04.07.00, Mumbai, India) covering literature from 2009-2024, with no geographic restriction. Economic evaluation studies used the Markov model and the risk-of-bias was assessed using the Drummond and Jefferson checklist. Abstracts and full texts were screened independently by two reviewers; uncertainties and disagreements were resolved through reconciliation or arbitration by a third independent reviewer.
RESULTS: A total of 20 studies were included: 12 cost-effectiveness, four HCRU, and eight for health care costs across different age groups, with a predominance of studies from East Asia (China, Hong Kong, Singapore). Among the paediatric population, the most cost-effective interventions included digital strategies for early prevention and screening, low-dose atropine (0.05%) with an incremental cost-effectiveness ratio of 234 USD/Spherical Equivalent Refraction reduction, and non-pharmacological defocus incorporated multiple segment lenses (7074 USD/quality-adjusted life year (QALY) gained). In adults, ranibizumab was cost-effective (35 288 USD/QALY gained) for pathologic myopia, while small incision lenticule extraction surgery yielded long-term savings (15 USD/QALY gained). Economic burden was largely driven by vision correction procedures and specialist visits, with notable regional and socioeconomic disparities in Spain and China. In adults, HCRU (frequent treatment, monitoring, hospitalisation, and emergency visits) was higher for myopic choroidal neovascularisation compared to paediatric population, and direct costs exceeded indirect costs.
CONCLUSION: s Myopia presents a substantial economic burden, highlighting the need for optimising cost-effective interventions to reduce severity, prevent long-term vision loss, and lessen the financial burden. However, limited data, geographical bias, methodological inconsistencies, and heterogeneity in outcomes emphasise the need for more standardised, comprehensive evaluations to ensure broader applicability.
METHODS: The systematic literature review was performed via the OVID SP® platform (software version 04.07.00, Mumbai, India) covering literature from 2009-2024, with no geographic restriction. Economic evaluation studies used the Markov model and the risk-of-bias was assessed using the Drummond and Jefferson checklist. Abstracts and full texts were screened independently by two reviewers; uncertainties and disagreements were resolved through reconciliation or arbitration by a third independent reviewer.
RESULTS: A total of 20 studies were included: 12 cost-effectiveness, four HCRU, and eight for health care costs across different age groups, with a predominance of studies from East Asia (China, Hong Kong, Singapore). Among the paediatric population, the most cost-effective interventions included digital strategies for early prevention and screening, low-dose atropine (0.05%) with an incremental cost-effectiveness ratio of 234 USD/Spherical Equivalent Refraction reduction, and non-pharmacological defocus incorporated multiple segment lenses (7074 USD/quality-adjusted life year (QALY) gained). In adults, ranibizumab was cost-effective (35 288 USD/QALY gained) for pathologic myopia, while small incision lenticule extraction surgery yielded long-term savings (15 USD/QALY gained). Economic burden was largely driven by vision correction procedures and specialist visits, with notable regional and socioeconomic disparities in Spain and China. In adults, HCRU (frequent treatment, monitoring, hospitalisation, and emergency visits) was higher for myopic choroidal neovascularisation compared to paediatric population, and direct costs exceeded indirect costs.
CONCLUSION: s Myopia presents a substantial economic burden, highlighting the need for optimising cost-effective interventions to reduce severity, prevent long-term vision loss, and lessen the financial burden. However, limited data, geographical bias, methodological inconsistencies, and heterogeneity in outcomes emphasise the need for more standardised, comprehensive evaluations to ensure broader applicability.