Clinical efficacy and cost-effectiveness of four myopia control interventions in children: a single-center retrospective study

To compare the one-year clinical efficacy and cost-effectiveness of single vision lenses (SVL), Myopia-control spectacle lenses (MCSL), Orthokeratology (Ortho-K), and Repeated Low-Level Red-Light (RLRL) therapy in children within a real-world setting. This retrospective observational cohort study analyzed data from 206 myopic children aged 8-14 years, who had already received one of four myopia control interventions: SVL (n = 50), MCSL (n = 60), Ortho-K (n = 44), or RLRL (n = 52). The primary outcomes were the change in axial length (AL) and spherical equivalent refraction (SER) after one year of intervention. The secondary outcome was the Incremental Cost-Effectiveness Ratio (ICER), calculated as the additional cost per 0.1 mm of AL elongation saved compared to the SVL group. All active interventions significantly outperformed SVL in controlling AL elongation (SVL mean: 0.42 mm/year). RLRL exhibited the greatest efficacy (mean AL change: 0.06 mm; 86.0% relative to SVL), with 31% of participants showing axial shortening. Ortho-K (0.18 mm; 57.5% efficacy) and MCSL (0.23 mm; 45.2% efficacy) also demonstrated substantial benefits. Mean annual direct medical costs were $140.93 (SVL), $429.44 (MCSL), $1,108.08 (Ortho-K), and $806.29 (RLRL). ICER analysis identified MCSL as the most cost-effective active intervention ($151.69 per 0.1 mm AL saved), followed by RLRL ($184.13), while Ortho-K yielded the highest ICER ($400.42). In this one-year study, RLRL therapy was observed to have the highest efficacy. However, the finding of axial shortening warrants validation in long-term randomized controlled trials (RCTs) to elucidate its mechanism and long-term safety. MCSL spectacle lenses were identified as the most cost-effective option, representing a well-balanced profile of efficacy and economic feasibility. Ortho-K, while a highly effective intervention, was associated with a greater financial burden.