Retinopathy of prematurity: Maharashtra state model

Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda

PURPOSE

With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo.

METHODS

Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model.

RESULTS

Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity.

CONCLUSION

The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

Retinopathy of prematurity in India - what can we learn from the polio legacy?

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the preterm retina that has the potential to cause vision impairment and blindness. Timely screening and treatment are hence critical for infants at risk for ROP. Screening for ROP is challenging in India owing to the limited resources, a vast at-risk population and lack of awareness among paediatricians and the public. Addressing ROP in India requires a comprehensive approach involving multiple sectors, considering the magnitude of the problem and the expected increase in need for ROP services due to the increased survival of preterm infants following improvements in neonatal care. The success of the Global Polio Eradication Initiative (GPEI) offers valuable lessons for improving ROP services in developing nations by applying its strategies. An approach for primary and secondary prevention of ROP is proposed, and the current challenges and a neonatal-led care model for ROP are discussed.

Unmet Need for ROP Screening in Peripheral Rural Areas

Aim

To study the incidence and risk factors associated with retinopathy of prematurity (ROP) at a tertiary care centre in Western India.

Methods

A retrospective review of records of both referred and babies born in our hospital who were screened for ROP within the last 21 months at a tertiary care centre was done. The newborns were screened as per National Neonatology Forum of India guidelines. ROP was classified according to the International Classification for Retinopathy of Prematurity criteria.

Results

A total of 167 neonates were screened with an incidence of ROP of 26.9%. The mean gestational age (GA) and mean birth weight (BW) were 31.89 ± 2.824 weeks and 1538.11 ± 530.84 gm. The mean BW of neonates having any ROP was significantly lower (1296.98gm, p < 0.001), and the mean GA was also significantly lower in ROP babies (30.67 weeks, p < 0.001). O2 supplementation, RDS, IVH, and NEC were the systemic risk factors that significantly correlated with ROP p-value <0.001. On analysis of the correlation of stage of ROP with BW and GA, a significant correlation of −0.307 (p < 0.001) and −0.283 (p < 0.001) was found.

Conclusion

The incidence of ROP in this study is similar to that reported in the literature from other regions. Other than LBW and GA, oxygen supplementation, RDS, IVH, and NEC were significant risk factors associated with ROP.