Digital technologies in enhancing hierarchical vision health management for the next 1000 days of children's life: multi-component economic evaluation.

Background: Visual impairment in the next 1000 days of children's life presents heavy medical and economic burdens. It is urgent to bridge the gap between early intensive healthcare engagement and school-based services to ensure timely detection during the pre-disease period. Digital technologies have shown promise but lack for economic evidence interventions targeting early childhood. Thus, we proposed and evaluated the economic value of a full-process digital-empowered hierarchical vision management strategy (FDH strategy) for preschool-age children in China. Methods: A decision-analytic Markov model was constructed to identify the cost-utility, cost-effectiveness and economic burdens among no intervention, traditional screening strategy, tele-screening strategy and FDH strategy for a hypothetical cohort which consists of 100,000 preschool children (3 years old). The parameters were obtained from published sources. Primary outcomes include incremental cost-utility ratios (ICURs), incremental cost-effectiveness ratios (ICERs), and net monetary benefit (NMB). ICURs were calculated using quality-adjusted life-years (QALYs), and ICERs using disability-adjusted life-years (DALYs). These outcomes were analyzed separately for rural and urban settings. Broad sensitivity analyses were performed to test the robustness of base-case analysis. Findings: Among all strategies evaluated, the FDH strategy was the most economically attractive option. It produced an ICUR of $780 (95% CI: 130-912) and an ICER of $5753 (95% CI: 1615-6894) in rural settings; it also exhibited had the lowest cost per QALY gained and per DALY averted in urban settings. Similarly, the FDH strategy had the highest NMB, with values increasing from $75 to $10,207 (rural) and $146 to $11,267 (urban) over the 15-year period. In rural areas, the FDH strategy reduced total myopia prevalence by 26.51%, high myopia by 15.35%, and combined strabismus, amblyopia and hyperopia by 12.6%. In urban areas, the corresponding reductions were 19.94%, 15.03%, and 5.97%. By further comparison, without LLM-based health promotion, costs were higher for achieving health benefits, which resulted in a cost increase of $146 per QALY gained and $2214 per DALY averted in rural settings; in urban settings, the increase was $273 per QALY gained and $1321 per DALY averted. All the above results were robust according to the sensitivity analysis. Interpretation: Multi-component health economics evaluations confirm the FDH strategy is highly cost-effective at a national level. This offers a valuable insight and economic rationale for promoting equitable, accessible, and sustainable eye health care during early childhood for countries with limited ophthalmic resources. Funding: This study was supported by grants from National Natural Science Foundation of China (82171051), National Natural Science Foundation of China (82371053), Excellent Young Scientists Fund of the National Natural Science Foundation of China (82422018), Development and Reform Pilot Project 2025: Research on Molecular Age Prediction Model of Eye and Whole Body Organs Based on Multi-omics and Imaging, Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes (PWD&RPP-MRI, JYY2023-6), and Sanming Project of Medicine in Shenzhen (SZSM202411009), Key Project of Beijing Natural Science Foundation for Young Scientists (JQ25021).