In the urban setting, in a hypothetical cohort of 1,000 children aged five to 15 years, the school-based screening averted 2.5 DALYs more than no screening at an incremental cost of $1,420 and the incremental cost per DALY averted was $574. The primary eye care screening averted 3.5 DALYs and cost $4,343 more than no screening. The incremental cost per DALY averted for primary care compared with school-based screening was $2,759.
For 1,000 children aged seven to 15 years, the school-based screening averted 8.6 DALYs at an incremental cost of $1,910 and the incremental cost per DALY averted was $221. The primary care screening averted 12.3 DALYs at an additional cost of $5,888. The incremental cost per DALY averted for primary care compared with school-based screening was $1,075.
In rural India, for 1,000 children aged seven to 15 years, the additional DALYs were 1.0 and costs were $1,235 and the incremental cost per DALY averted was $1,211 for school-based screening, while the incremental DALYs were 1.5 and costs were $3,760 for primary care screening, over no screening. The incremental cost per DALY averted for primary care compared with school-based screening was $5,775.
The sensitivity analysis showed that changes in the base-case inputs made school-based screening less favourable and no screening more attractive in urban children aged five to 15 years. Variations in the baseline inputs did not alter the findings, in the other cohorts.
Using the Indian gross domestic product (GDP) as a threshold, school-based screening had a 100% probability of being cost-effective for urban children aged five to 15 years, while at three times the GDP threshold, primary eye care screening had a 68.7% probability of being cost-effective.