Abstract 1459 Health Services Research: Access and Organization Poster Symposium, Saturday, 5/1

BACKGROUND: Canadian Pediatric Society (CPS) and American Academy of Pediatric (AAP) Guidelines currently recommend routine ROP screening for all infants ≤1,500g BW or ≤30 weeks gestation, and ≤1,500g BW or ≤28 weeks, respectively. To determine the cost-effectiveness of these and more recent recommendations (Goble et al: ≤1,250g BW or ≤29 weeks), we examined data from the Canadian NICU Network, comprising all 19,510 infants admitted to 17 Canadian NICUs from Jan 1996 to Oct 1997.

METHOD: Infants were categorized by gestation and birth weight. For each group, numbers of infants who were screened, who developed ROP ≥ grade 3, and who required treatment for ROP, were obtained. Cost estimates were developed from the viewpoint of the provincial payer (B.C. costs) and included costs of screening tests, treatment for ROP, and related transport costs. Estimates of poor ophthalmic outcomes were obtained from efficacy data in recent treatment trials.

RESULTS: The marginal cost (MC) per additional adverse eye outcome (AAEO) increases and treated cases missed (TM) decreases as infants of greater gestational age are screened but rises significantly above 28 weeks gestation. Combining gestation with birth weight criteria decreases the MC, but birth weight criteria (≤1,200g) alone is most cost-effective (see Table).

Table 1 No caption available
Full size table

CONCLUSIONS: Present ROP screening guidelines can be relaxed to ≤1,200g BW without decreasing the detection rate of ROP cases requiring treatment. 1 case (1785g BW, 32 wk gest) is missed by all existing screening criteria and will require significantly more MC/AAEO to detect. Identification of risk factors for ROP may permit detection of such outlier infants without widening the ROP screening criteria.

Funded by the Medical Research Council of Canada