Paper title: Establishing a method to estimate the effect of antimyopia management options on lifetime cost of myopia
Authors: Tim R Fricke (1,2,3), Padmaja Sankaridurg (1,3), Thomas Naduvilath (1,3), Serge Resnikoff (1,3), Nina Tahhan (1,3), Mingguang He (4,5), Kevin D Frick (6)
- Brien Holden Vision Institute, Sydney, New South Wales, Australia
- Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, Victoria, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Zhongshan Ophthalmic Centre, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Johns Hopkins Carey Business School, Baltimore, Maryland, USA
Date: Mar 2022
Reference: Fricke TR, Sankaridurg P, Naduvilath T, Resnikoff S, Tahhan N, He M, Frick KD. Establishing a method to estimate the effect of antimyopia management options on lifetime cost of myopia. Br J Ophthalmol. 2022 Mar 9: bjophthalmol-2021-320318.
This study described a methodology for estimating and comparing the lifetime financial costs of active myopia management (AMM) and traditional, non-treatment myopia correction (TMM) options, meaning single-vision correction.
The authors used exemplars of an 8 year old presenting with symptomatic -0.75D correction in both eyes in urban areas of Australia and China who is supplied with AMM or TMM options. The AMM products were available in both countries and the costs of all product types, necessary appointment fees and other related costs were based on information supplied by key sources in both.
The refractive outcome profile for each scenario differed for myopia progression and so costs were weighted according to the expected refractive outcome for each. Future costs were discounted at 3% per annum, with 0% and 5% per annum discounting serving as sensitivity analyses.
The lifetime costs for TMM (3% discounting) were found to be:
- US$7437 in Australia and
- US$8006 in China.
AMM options included low-dose atropine, anti-myopia spectacles and soft contact lenses and orthokeratology. The lifetime costs (also 3% discounting) for these were:
- US$7280 in Australia and
- US$4453 in China
The financial implications for active myopia management during childhood can be balanced across a lifetime. Active myopia management options generally showed higher costs in childhood compared to traditional corrective methods, although TMM costs were more expensive later in life than AMM with higher myopia.
Future savings from utilizing AMM - the benefits of lower final myopia - include reduced frequency of prescription changes, lower risk of myopia-related pathology and vision loss, and less expensive correction needed once treatment is finished.
What does this mean for my practice?
There are increased costs involved in the production and supply of active myopia management treatments compared to traditional (single vision correction) options, although myopia management options represent savings from lower myopia in later life despite the initial outlay.
Eyecare practitioners can discuss this balance with a child’s parents when the need for AMM options arises. The investment in AMM in childhood is a benefit to that person in reducing the personal, functional and financial costs of future higher myopia.
What do we still need to learn?
1. If treatment efficacy will influence the costs of AMM:
- For the purposes of the cost modelling, the treatment period was continuous over 10 years
- An individual may finish treatment sooner or later than this, therefore the costs may be reduced for some patients and higher for others
- The efficacy can be influenced by ethnicity and age
2. How the costs of assistance care for patients with visual impairment due to high myopia may affect the modelling - this expense was not included in the future costs of higher myopia.
3. How prices will change over time - consumer trends and professional preferences will impact the supply, demand and competition for AMM treatment options.
Title: Establishing a method to estimate the effect of antimyopia management options on lifetime cost of myopia
Authors: Tim R Fricke, Padmaja Sankaridurg, Thomas Naduvilath, Serge Resnikoff, Nina Tahhan, Mingguang He, Kevin D Frick
Purpose: Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using exemplars in Australia and China.
Methods: We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% annual discounting, where discounting adjusts future costs to 2020 value.
Results: Low-dose atropine, antimyopia spectacles, antimyopia multifocal soft contact lenses and orthokeratology met our AMM inclusion criteria. Lifetime cost for TMM with 3% discounting was US$7437 (CI US$4953 to US$10 740) in Australia and US$8006 (CI US$3026 to US$13 707) in China. The lowest lifetime cost options with 3% discounting were antimyopia spectacles (US$7280, CI US$5246 to US$9888) in Australia and low-dose atropine (US$4453, CI US$2136 to US$9115) in China.
Conclusions: Financial investment in AMM during childhood may be balanced or exceeded across a lifetime by reduced refractive progression, simpler lenses, and reduced risk of pathology and vision loss. Our methodology can be applied to estimate cost in comparable scenarios.
Ailsa Lane is a contact lens optician based in Kent, England. She is currently completing her Advanced Diploma In Contact Lens Practice with Honours, which has ignited her interest and skills in understanding scientific research and finding its translations to clinical practice.