A SYSTEMATIC REVIEW ON ECONOMIC EVALUATION OF LOW-DOSE ATROPINE FOR CHILDHOOD MYOPIA CONTROL: EVIDENCE FROM MODEL INSIGHTS
Author(s)
Sui Chee Fai, PhD1, Long Chiau Ming, PhD2, Chin Hui Ng, PhD3.
1STUDENT, SUNWAY UNIVERSITY, Bandar Sunway, Malaysia, 2SUNWAY UNIVERSITY, Sunway University, Malaysia, 3Hospital Raja Permaisuri Bainun, Ipoh, Malaysia.
1STUDENT, SUNWAY UNIVERSITY, Bandar Sunway, Malaysia, 2SUNWAY UNIVERSITY, Sunway University, Malaysia, 3Hospital Raja Permaisuri Bainun, Ipoh, Malaysia.
OBJECTIVES: Childhood myopia imposes substantial lifetime costs through refractive care, productivity loss, and complications such as myopic macular degeneration and retinal detachment. This review aimed to map model-based economic evaluations of low-dose atropine (LDA) for myopia control in children, characterize model structures and assumptions, and assess how dose, perspective, and time horizon influence cost-effectiveness conclusions.
METHODS: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and ProQuest were updated to June 2025, extending a prior review with atropine-specific terms. Eligible studies were full economic evaluations analyses of atropine in children, reporting costs plus at least one economic outcome in English. Selection, extraction, and appraisal followed PRISMA, CHEERS, and ECOBIAS guidance. Costs were standardized to 2023 USD. Conference abstracts were mapped descriptively as supplementary evidence.
RESULTS: Three peer-reviewed model-based studies met inclusion criteria. All adopted societal perspectives and found LDA (0.01-0.05%) cost-effective or cost-saving versus usual care over 5-year to lifetime horizons. A New Zealand Markov model reported an ICER of ~USD1116/QALY for school photo-refraction plus 0.01% atropine, below a one-times GDP threshold. Lifetime models in China and Australia suggested societal cost reductions or near-neutral costs, driven by avoided high myopia and complications. A Hong Kong Markov model showed acceptable ICERs per diopter reduction for 0.01% and 0.05% atropine compared with single-vision lenses. Two LAMP-derived conference models consistently ranked 0.05% as most cost-effective, followed by 0.025% and 0.01%, and confirmed this ranking across 20- and 80-year horizons, with stronger economic advantage in ages 4-12 years.
CONCLUSIONS: Model-based evidence supports LDA as an economically attractive strategy for childhood myopia control, with lifetime benefits largely driven by reduced progression to high and pathological myopia. 0.05% may provide the most favorable long-term value among low-dose regimens, but robust trial-based cost-utility analyses with region-specific inputs, are needed to inform reimbursement and public health programs.
METHODS: A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and ProQuest were updated to June 2025, extending a prior review with atropine-specific terms. Eligible studies were full economic evaluations analyses of atropine in children, reporting costs plus at least one economic outcome in English. Selection, extraction, and appraisal followed PRISMA, CHEERS, and ECOBIAS guidance. Costs were standardized to 2023 USD. Conference abstracts were mapped descriptively as supplementary evidence.
RESULTS: Three peer-reviewed model-based studies met inclusion criteria. All adopted societal perspectives and found LDA (0.01-0.05%) cost-effective or cost-saving versus usual care over 5-year to lifetime horizons. A New Zealand Markov model reported an ICER of ~USD1116/QALY for school photo-refraction plus 0.01% atropine, below a one-times GDP threshold. Lifetime models in China and Australia suggested societal cost reductions or near-neutral costs, driven by avoided high myopia and complications. A Hong Kong Markov model showed acceptable ICERs per diopter reduction for 0.01% and 0.05% atropine compared with single-vision lenses. Two LAMP-derived conference models consistently ranked 0.05% as most cost-effective, followed by 0.025% and 0.01%, and confirmed this ranking across 20- and 80-year horizons, with stronger economic advantage in ages 4-12 years.
CONCLUSIONS: Model-based evidence supports LDA as an economically attractive strategy for childhood myopia control, with lifetime benefits largely driven by reduced progression to high and pathological myopia. 0.05% may provide the most favorable long-term value among low-dose regimens, but robust trial-based cost-utility analyses with region-specific inputs, are needed to inform reimbursement and public health programs.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE485
Topic
Economic Evaluation
Disease
SDC: Pediatrics, SDC: Sensory System Disorders (Ear, Eye, Dental, Skin)