Investigators Suggest New, Cost-Effective Screening Strategies for ROP

Kasia Trzcionkowska, PhD

A team of investigators from the Netherlands suggested that the current Dutch retinopathy of prematurity (ROP) could be improved through the implementation of new screening inclusion criteria, with the most effective strategy detailed in the study being able to reduce the number of screened infants by 24% compared to the current guideline.

These strategies could also reduce overall annual costs of current ROP screening, which was estimated at €59454, or roughly $62,600.

The team, led by Kasia Trzcionkowska, PhD, of Leiden University, defined ROP as “the most important cause of visual impairment and blindness” in premature infants. Though most cases are mild and regressive, early detection and treatment of ROP has been advised to prevent severe and permanent loss of sight.

Several updates and risk-based screening criteria for the Netherlands’ first national ROP inventory, NEDROP, in 2013 and 2017, resulting in a second national ROP inventory called NEDROP 2. In both instances, the number of infants required for ROP screening was reduced.

Trzcionkowska and colleagues evaluated the effects and costs of current and alternative ROP screening strategies and considered whether the number of infants who would require ROP screening could be reduced.

The Methods

The team utilized data from an earlier prospective population-based study, the NEDROP-2 study, which featured data from all infants born in 2017 and referred for ROP screening in the Netherlands.

A variety of screening strategies were featured in the study and evaluated based on gestational age (GA), birth weight (BW), and the presence of 1 or more specific risk factors including mechanical ventilation, sepsis, necrotizing enterocolitis, postnatal corticoids and/or hypotension treated with inotropic agents.

The investigators considered the cost and effects of all available strategies.

The Findings

Screening was performed in a total of 1088 patients, and ROP was found in 305, with 259 being considered mild and 47 deemed severe.

Investigators determined that the most efficient strategy in detecting infants treated for ROP included infants with GA < 30 weeks and BW < 1250 g and GA 30–32 weeks and/or BW 1250–1500 g in addition to 1 or more risk factors.

This particular strategy would require that 744 children were screening, which represented a 23.8% reduction in comparison to the current screening guideline.

Likewise, only 2662 screening examinations would be done if this strategy was applied to the NEDROP population, representing a 18.7% reduction in screening done under the current guideline.

Costs varied from €137 966 to €492 689 depending on the strategy, with the total annual costs of the current Dutch guideline treatment for ROP amounting to €552 143.

The investigative team suggested that the Dutch national screening guideline would be adjusted according to the cost-effective strategies detailed in the study.

“This will reduce healthcare costs further by about 60 000 euro per year,” the team wrote. “Marginal costs for detecting all these infants might be acceptable for society when QALY gain and savings for society as a result of improved vision are incorporated in the decision.”