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Shoo K. Lee, MBBS, FRCPC, PhD; Charles Normand, BA, DPhil; Douglas McMillan, MD, FRCPC; Arne Ohlsson, MD, FRCPC, MSc; Michael Vincer, MD, FRCPC; Christopher Lyons, MBBS, FRCSC; for the Canadian Neonatal Network

Arch Pediatr Adolesc Med. 2001;155:387-395.

Context  Existing guidelines recommended by the Canadian Pediatric Society (CPS) and American Academy of Pediatrics (AAP) for routine screening for retinopathy of prematurity (ROP) remain controversial.

Objective  To determine whether current guidelines for routine screening for ROP should be changed.

Design  We examined data that were collected as part of a larger study of 14 neonatal intensive care units (NICUs) in Canada. We examined the effect of strategies using different birth weight (BW) and gestational age (GA) criteria for routine ROP screening, and performed a cost-effectiveness analysis.

Setting  The 14 NICUs (except one) are regional tertiary level referral centres serving geographic regions of Canada, and include approximately 60% of all tertiary-level NICU beds in Canada.

Patients  This large cohort included all 16 424 infants admitted to 14 Canadian NICUs from January 8, 1996, to October 31, 1997.

Interventions  None.

Main Outcome Measure  Treatment for ROP.

Results  The most cost-effective strategy was to routinely screen only infants having a BW of 1200 g or less. This included all infants treated for ROP (except 1 outlier at 32 weeks GA and 1785 g BW), at a marginal cost per additional person with improved vision of $513 081 for screening patients between 28 weeks GA and 1200 g BW, compared with $1 800 039 and $2 075 874 for using the current AAP and CPS guidelines, respectively (cryotherapy outcomes). Results for laser therapy were similar, but costs were slightly lower. This strategy reduced the number of infants screened under the current CPS guidelines by 46%.

Conclusion  Screening only infants having a BW of 1200 g or less is the most cost-effective strategy for routine ROP screening.

From the Department of Pediatrics, University of British Columbia, and the Centre for Community Health and Health Evaluation Research,Vancouver, British Columbia (Dr Lee); the London School of Hygiene and Tropical Medicine, London, England (Dr Normand); the Department of Pediatrics, University of Calgary, Alberta (Dr McMillan); the Department of Pediatrics, University of Toronto, Ontario (Dr Ohlsson); the Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia (Dr Vincer); and the Department of Ophthalmology, University of British Columbia (Dr Lyons).

Corresponding author and reprints: Shoo K. Lee, MBBS, FRCPC, PhD, Canadian Neonatal Network, Canadian Neonatal Network Coordinating Centre, 4480 Oak St, Room E-414, Vancouver, British Columbia, Canada V6H 3V4 (e-mail: shool{at}interchange.ubc.ca).

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