Cost-effectiveness of cycloplegic agents: Results of a randomized controlled trial in Nigerian children

Ebri, A; Kuper, H; Wedner, S; (2007) Cost-effectiveness of cycloplegic agents: Results of a randomized controlled trial in Nigerian children. Investigative ophthalmology & visual science, 48 (3). pp. 1025-1031. ISSN 0146-0404 DOI:

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PURPOSE. To compare the cost and effectiveness of three cycloplegic agents among Nigerian children. METHODS. Two hundred thirty-three children aged 4 to 15 years attending outpatient eye clinics in Nigeria were randomized to (1) 1% cyclopentolate, (2) 1% cyclopentolate and 0.5% tropicamide, or (3) 1% atropine drops in each eye (instilled at home over 3 days). Ten children were lost to follow-up, nine from the atropine group. An optometrist measured the residual accommodation (primary outcome), dilated pupil size, pupil response to Light, and self-reported side effects (secondary outcomes). Caregivers were interviewed about costs incurred due to cycloplegia (primary outcome). The incremental cost effectiveness ratios (ICERs) were calculated as the difference in cost divided by the difference in effectiveness comparing two agents. The 95% confidence intervals (CI) for ICERs were estimated through bootstrapping. RESULTS. The atropine group had significantly lower mean residual accommodation (0.04 +/- 0.01 D [SE]), than the combined regimen (0.36 +/- 0.05 D) and cyclopentolate (0.63 +/- 0.06 D) groups (P < 0.001). Atropine and the combined regimen produced better results for negative response to light and dilated pupil size than cyclopentolate. Atropine was more expensive, but also more effective, than the other agents. The ICER comparing atropine to the combined regimen was 1.81 (95% CI = -6-31-15-35) and compared to cyclopentolate was 0.59 (95% CI = -3.47-5.47). The combined regimen was both more effective and less expensive than cyclopentolate alone. CONCLUSIONS. A combination of cyclopentolate and tropicamide should become the recommended agent for routine cycloplegic refraction in African children. The combined regimen was more effective than cyclopentolate, but not more expensive, and was preferable to atropine, since it incurred fewer losses to follow-up.

Item Type: Article
Keywords: REFRACTIVE ERROR, VISUAL IMPAIRMENT, CYCLOPENTOLATE, 1-PERCENT, EFFICACY, ATROPINE, IRIDES, Accommodation, Ocular, drug effects, Adolescent, Atropine, administration & dosage, economics, Child, Child, Preschool, Cost of Illness, Cost-Benefit Analysis, Cyclopentolate, administration & dosage, economics, Drug Costs, Drug Therapy, Combination, Female, Health Care Costs, Humans, Male, Mydriatics, administration & dosage, economics, Nigeria, Ophthalmic Solutions, administration & dosage, economics, Pupil, drug effects, Refractive Errors, diagnosis, economics, Tropicamide, administration & dosage, economics
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: The International Centre for Evidence in Disability
International Centre for Eye Health
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 17325142
Web of Science ID: 244686500012


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