COST-EFFECTIVENESS OF LOW-DOSE ATROPINE VERSUS ORTHOKERATOLOGY FOR MYOPIA CONTROL IN CHILDREN

OBJECTIVES: Pediatric myopia is increasing rapidly worldwide and is associated with elevated risk of vision-threatening complications. Low-dose atropine eye drops and orthokeratology (OK) lenses are commonly used interventions to slow axial elongation; however, their comparative economic value remains uncertain. This study evaluated the cost-effectiveness of low-dose atropine versus OK lenses for pediatric myopia control from a U.S. patient perspective.
METHODS: A Markov cohort model was developed in TreeAge Pro 2025 to simulate myopia progression across low, moderate, and high-severity states over a five-year horizon. Treatment efficacy inputs were obtained from published clinical trials and supplemented with longitudinal real-world data from the University of Houston Eye Care clinic. Axial length (AL) reduction was used as a validated surrogate outcome for long-term myopia-related risk. Direct patient costs included treatment-related visits, devices or medications, and routine vision correction as applicable. Outcomes included total costs, incremental cost-effectiveness ratios (ICERs) per 1-mm AL reduction, and net monetary benefit (NMB) across willingness-to-pay (WTP) thresholds ranging from USD 1,000 to 10,000 per mm. Probabilistic sensitivity analyses were conducted to assess parameter uncertainty.
RESULTS: Over five years, low-dose atropine incurred mean costs of USD 5,333 and achieved 0.35 mm of AL reduction, while OK lenses cost USD 7,433 and achieved 0.55 mm of AL reduction. Compared with atropine, OK lenses provided an additional 0.20 mm AL reduction at an incremental cost of USD 2,100, yielding an ICER of USD 10,702 per mm AL reduction. Across all WTP thresholds examined, atropine demonstrated higher NMB, indicating greater cost-effectiveness relative to OK lenses. Results were most sensitive to OK-related costs and treatment effectiveness.
CONCLUSIONS: Although orthokeratology achieved greater AL reduction, its higher patient costs resulted in lower cost-effectiveness per unit AL reduction at commonly considered WTP thresholds. From a U.S. patient perspective, low-dose atropine represents a more economically favorable and accessible first-line strategy.