A proof-of-concept simulation experiment demonstrated that screening for myopia with photorefraction at age 11 years and administering low-dose atropine 0.01% to children screening positive was likely cost effective, according to research published in Clinical Ophthalmology.

Investigators developed a hybrid decision tree Markov model which compared long-term clinical and economic outcomes of a screening program for myopia in New Zealand (NZ). The team assigned hypothetical cohorts (individuals aged 11 years with death at 80 years who screened positive) to 1 of 2 care regimens: corrective lenses with optometry or treatment with atropine drops. The model included normal, myopic, high myopic, pathological myopic, and blind eye states. Following the simulation, researchers estimated accumulated costs and health outcomes, and determined willingness to pay (WTP) per quality-adjusted life-year (QALY).

The team determined that WTP was $58,000 per QALY (NZ). They estimated an incremental increase of 0.0129 (95% CI, 0.0127- 0.0131) QALYS for each individual that was screened. This equated with an increased cost of $17.70 (NZ) per individual screened and an incremental cost-effectiveness ratio (ICER) of $1590.42 (NZ) per QALY gained in atropine treatment vs corrective lenses. Investigators estimate that for every 100,000 patients screened, 7 cases of blindness, 462 cases of pathological myopia, and 816 cases of high myopia would be prevented with atropine treatment. They determined that 14,286 screenings needed to occur to prevent 1 case of blindness.

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Sensitivity analysis identified the cost of pathological myopia, discount rate, and treatment efficacy as factors most affecting cost-effectiveness.

“Screening for myopia with photorefraction at age 11 and atropine 0.01% eye drop treatment of children screening positive is likely to be cost-effective,” according to the investigators. “These results suggest that a real-world trial and cost-effectiveness analysis would be worth considering in New Zealand.”

Study limitations include the use of a hypothetical model instead of a real-world trial. 

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Hong CY, Boyd M, Wilson G, Hong SC. Photorefraction screening plus atropine treatment for myopia is cost-effective: a proof-of-concept Markov analysis. Clin Ophthalmol. 2022;16:1941-1952. doi:10.2147/OPTH.S362342