Scope and costs of autorefraction and photoscreening for childhood amblyopia—a systematic narrative review in relation to the EUSCREEN project data

Autor: Arinder Channa, Huibert J. Simonsz, Mandy Nordmann, P. Mazzone, Anna M. Horwood, Helen Griffiths, Jill Carlton
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Eye
ISSN: 1476-5454
0950-222X
Popis: Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally.A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality.Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably.Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.摘要: 针对视力降低 (VA) 、屈光危险因素或两者可进行弱视筛查。 VA测试在4岁以下是不精确的, 因此自动风险因素照片的筛选似乎是一个可行的选择。与EUSCREEN项目ʻ国别报告’ (该报告描述了国际上如何使用光筛和自动筛查) 相比, 本评论考虑了社区服务中使用的图像筛查方法, 重点关注成本, 成本效益和使用范围。 方法: 截至2018年9月10日, 我们使用搜索词在公众平台对所有英文文献进行了系统性回顾。在考虑成本的情况下, 使用了CASP经济评估清单来评估数据质量。 结果: 在370个摘要中, 有55个报告了大型社区图像筛选项目。没有原始数据的情况下, 有五个考虑了成本效益问题。在71% 的项目中, 图像筛选是一个独立的, 唯一的测试项目。相比之下, EUSCREEN 45个国家报告中的25个表明, 图像筛查通常只对既定程序中的其他测试进行补充, 并且很少将其用作独立测试的项目。成本差异很大, 在文献或国际惯例中, 成本效益的证据很少。只有八篇 (13%) 论文比较了图像筛查和VA测试的诊断准确性或成本效益, 而这样做时, 图像筛查的成本效益却不佳。 讨论: 与后者VA筛查相比, 图像筛查在降低弱视或斜视患病率或改善总体预后的证据方面 薄弱, 成本效益的证据也很少。目前, 最具成本效益的选择似乎是专家VA筛查, 并有机会在转诊前进行重新测试。.
Databáze: OpenAIRE
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