Abstract
<title>Abstract</title> <p>Background/Objectives. To estimate the cost-utility of atropine-based myopia control versus single-vision (SV) correction in US children, crediting both prevented myopia-associated complications and the ongoing refractive-functional burden of higher myopia as quality-adjusted life years (QALYs). Subjects/Methods. We analysed 553 children on atropine-based treatment at one US practice; atropine monotherapy (n = 443) was primary. Adult spherical equivalent refraction (SER) at age 30 was projected, and a two-segment logistic function mapped projected SER to lifetime risk of myopic maculopathy, retinal detachment, primary open-angle glaucoma and posterior subcapsular cataract. Onset-timed, survival-weighted prevention QALYs were combined with an ongoing refractive-functional decrement (δ = 0.002/dioptre/year). The two co-primary analyses were a Total-Value model and a Pathology-Only reference; incremental cost-effectiveness ratios (ICERs) versus SV used one-way, probabilistic and bootstrap analyses. Results. For atropine monotherapy, the modelled age-30 SER difference averaged 1.14 D. The payer ICER was US$13,671/QALY for Total-Value (bootstrap 95% CI 12,323–15,309) and $31,507 for Pathology-Only (26,910–37,461); the refractive-functional stream contributed the larger share, and myopic maculopathy about 72% of the pathology benefit. The probability of cost-effectiveness at $50,000/QALY was 1.00 (Total-Value) and 0.94 (Pathology-Only). The principal dependency was durability of the refractive separation (ICER $28,640 if functional accrual was truncated at observed follow-up; $78,257 if separation was lost by age 30). Conclusions. Atropine monotherapy was cost-effective versus SV. The Total-Value analysis, which recognises a modest ongoing burden of correction dependence, was more favourable, while the Pathology-Only result remained cost-effective. Estimates depend on persistence of the refractive separation and the discount rate.</p>