Systematic review of atropine cost-effectiveness in childhood myopia management
6 affiliations
- 1Faculty of Medical and Life Sciences, Sunway University
- 2Pharmacy Department, Hospital Raja Permaisuri Bainun
- 3PPD, Inc., Thermo Fisher Scientific
- 4Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga
- 5Innovative Pharmacy Practice and Integrated Outcomes Research (INACORE), Faculty of Pharmacy Universitas Airlangga
- 6Research Center in Advancing Community Healthcare (REACH), Universitas Airlangga
Abstract
Background: Childhood myopia is a global public health concern, with rising prevalence and a significant economic burden due to complications like retinal detachment and macular degeneration. Low-dose atropine (LDA) range 0.01%–0.05% is a clinically effective intervention for slowing myopia progression. However, its economic value remains under-evaluated across diverse settings.
Methods and Findings: We conducted a systematic review following PRISMA guidelines and registered in PROSPERO (CRD420251009680) to assess the cost-effectiveness of atropine for myopia management in children. Four model-based economic evaluations met the inclusion criteria, from Hong Kong, New Zealand, Australia/China and France/United Kingdom. Two studies used Markov cohort state-transition models while two employed a cohort decision-analytic model with probabilistic simulation of refractive outcomes. All four economic evaluations adopted a societal perspective; each applied a 3% annual discount rate to costs in their analyses and reported sensitivity analyses around discounting. Time horizons ranged from 5 years for incident myopia to lifetime horizons capturing myopia complications and vision impairment. Across economic models, LDA was consistently found to be cost-effective or cost-saving compared with standard care. Reported incremental cost-effectiveness ratios (ICERs) included approximately NZ$1,590 per quality-adjusted life year (QALY) gained in a New Zealand Markov cost–utility model, and USD 220–275 per diopter spherical equivalent reduction in a 5-year Hong Kong cost-effectiveness analysis. Evidence from high- and middle-income settings indicates that low-dose atropine is a cost-effective strategy, particularly when long-term progression to high myopia and its associated complications is considered. In European settings, low-dose atropine demonstrated a favorable cost profile compared with standard correction in children at higher risk of myopia progression, with consistent findings of cost-neutrality or cost savings when downstream costs of high myopia were included.
Conclusion: Studies demonstrate favourable economic value using diverse metrics, including cost per diopter reduction, cost ratios, and cost–utility estimates, rather than uniformly reported ICERs. Greater economic benefits are observed over longer time horizons, largely driven by the avoidance of high myopia–related complications and associated costs.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251009680 , identifier PROSPERO CRD420251009680.
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BibTeX
@article{sui2026systematic,
title = {{Systematic review of atropine cost-effectiveness in childhood myopia management}},
author = {Chee Fai Sui and Chin Hui Ng and Yee Chang Soh and Kah Seng Lee and Andi Hermansyah and Long Chiau Ming},
journal = {Frontiers in Pharmacology},
year = {2026},
month = oct,
doi = {10.3389/fphar.2026.1836579},
url = {https://www.frontiersin.org/articles/10.3389/fphar.2026.1836579/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Systematic review of atropine cost-effectiveness in childhood myopia management
AU - Chee Fai Sui
AU - Chin Hui Ng
AU - Yee Chang Soh
AU - Kah Seng Lee
AU - Andi Hermansyah
AU - Long Chiau Ming
PY - 2026
DA - 2026/10/16
JO - Frontiers in Pharmacology
DO - 10.3389/fphar.2026.1836579
UR - https://www.frontiersin.org/articles/10.3389/fphar.2026.1836579/full
AB - Background: Childhood myopia is a global public health concern, with rising prevalence and a significant economic burden due to complications like retinal detachment and macular degeneration. Low-dose atropine (LDA) range 0.01%–0.05% is a clinically effective intervention for slowing myopia progression. However, its economic value remains under-evaluated across diverse settings. Methods and Findings: We conducted a systematic review following PRISMA guidelines and registered in PROSPERO (CRD420251009680) to assess the cost-effectiveness of atropine for myopia management in children. Four model-based economic evaluations met the inclusion criteria, from Hong Kong, New Zealand, Australia/China and France/United Kingdom. Two studies used Markov cohort state-transition models while two employed a cohort decision-analytic model with probabilistic simulation of refractive outcomes. All four economic evaluations adopted a societal perspective; each applied a 3% annual discount rate to costs in their analyses and reported sensitivity analyses around discounting. Time horizons ranged from 5 years for incident myopia to lifetime horizons capturing myopia complications and vision impairment. Across economic models, LDA was consistently found to be cost-effective or cost-saving compared with standard care. Reported incremental cost-effectiveness ratios (ICERs) included approximately NZ$1,590 per quality-adjusted life year (QALY) gained in a New Zealand Markov cost–utility model, and USD 220–275 per diopter spherical equivalent reduction in a 5-year Hong Kong cost-effectiveness analysis. Evidence from high- and middle-income settings indicates that low-dose atropine is a cost-effective strategy, particularly when long-term progression to high myopia and its associated complications is considered. In European settings, low-dose atropine demonstrated a favorable cost profile compared with standard correction in children at higher risk of myopia progression, with consistent findings of cost-neutrality or cost savings when downstream costs of high myopia were included. Conclusion: Studies demonstrate favourable economic value using diverse metrics, including cost per diopter reduction, cost ratios, and cost–utility estimates, rather than uniformly reported ICERs. Greater economic benefits are observed over longer time horizons, largely driven by the avoidance of high myopia–related complications and associated costs. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251009680 , identifier PROSPERO CRD420251009680.
SN - 1663-9812
ER -