Presentation (CTI)

OBJECTIVES: This study systematically reviewed model-based economic evaluations of low-dose atropine (LDA) in children to describe analytic approaches, compare outcomes and cost components, and assess whether LDA is consistently cost-effective or cost-saving relative to conventional optical correction (COC).
METHODS: A protocol was registered in PROSPERO, and the review followed PRISMA guidelines. Initial five database searches were conducted and updated to identify economic evaluations of LDA for myopia in children with a comparator and at least one economic outcome (ICER, cost/diopter, lifetime cost ratio). Methodological quality was appraised using CHEERS and ECOBIAS. All costs were converted to 2024 USD. Given heterogeneity in structures, horizons, and outcome metrics, results were synthesised narratively, focusing on direction of effect rather than pooled ICERs.
RESULTS: Four model-based studies met inclusion criteria, with models from Hong Kong, New Zealand, Australia/China, and France/United Kingdom. Two studies used Markov cohort models (5-year and lifetime horizons), while two applied probabilistic cohort cost-consequence models, generating lifetime refractive-outcome distributions. All adopted societal perspectives and 3% discounting. A New Zealand study reported an ICER of NZ$1,590/QALY gained for photorefraction screening plus LDA versus COC. A Hong Kong study reported a US$220-275 per diopter spherical equivalent reduction over 5 years for 0.01-0.05% atropine. Authors Fricke and Lee found LDA (0.01-0.05% grouped) to be cost-saving or near cost-neutral versus COC for higher-risk progressors when lifetime refractive correction and complication costs were included. Across studies, short-term costs were driven by drugs plus follow-up visits, whereas lifetime savings were driven by reduced high-myopia complications and productivity losses.
CONCLUSIONS: Despite methodological heterogeneity and limited study numbers, all identified models concluded that LDA is cost-effective or cost-saving versus COC for pediatric myopia control, particularly in faster progressors and over lifetime horizons. These findings support LDA as a high-value intervention and highlight priorities for future CEAs in Europe and Asia.