Modelling direct healthcare costs for screening and treatment of retinopathy of prematurity among infants born at gestational age <24 weeks - findings from a Swedish cohort

Q: What data and cohort were used to estimate ROP screening and treatment costs?

The analysis used all 399 Swedish infants born at 22–23 weeks (2007–2018) who underwent ROP screening, recorded in the national SWEDROP registry.

Q: Which treatment pathways were compared in the cost model?

The model compared no sight-saving treatment, laser as initial treatment, and anti-VEGF as initial treatment, with laser/anti-VEGF further divided into single versus multiple treatments.

Q: What were the key findings regarding screening burden and overall costs?

In the basic model, laser was associated with fewer screenings and retreatments than anti-VEGF. Although per-infant treatment costs were slightly lower for anti-VEGF, overall costs were similar or slightly higher, driven by a higher screening burden in the anti-VEGF group.

Sep 29, 2026

Upload by Sophia Brooks

Objective: Sweden actively manages infants born extremely preterm at 22–23 weeks’ gestational age. The study analyses retinopathy of prematurity (ROP) screening and treatment pathways in these infants, assessing costs and health outcomes to build a model of direct healthcare costs. Method and analysis: Using national SWEDROP data for 399 infants screened for ROP (2007–2018), an economic decision-tree model compared no sight-saving treatment, laser, and anti-VEGF, with expanded modeling by gestational age and comorbidities.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Objective and aim

Methods and analysis

Results

Conclusion

Introduction

ROP background and clinical pathway

Rationale for decision-tree modeling

What is already known on this topic

What this study adds

How this study might affect research, practice or policy

Original research To cite: Löfqvist C, Sharma S, Hellström A, et al. Modelling direct healthcare costs for screening and treatment ofretinopathy of prematurity among infants born at gestational age <24 weeks: findings from a Swedish cohort. BMJ Open Ophthalmology 2025;10:e002507 . doi:10 . 1136/ bmjophth-2025-002507 ► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi.org/](https://doi.org/)[ ](https://doi.org/)[10.1136/bmjophth-2025-](10.1136/bmjophth-2025-)[ ](10.1136/bmjophth-2025-)[002507](002507)) . Received 26 November 2025 Accepted 17 December 2025 © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group. 1Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 2Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden 3University of Gothenburg Centre for Person-centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Correspondence to Dr Hanna Gyllensten; hanna. [gyllensten@gu.se](gyllensten@gu.se) Modelling direct healthcare costs for screening and treatment of retinopathy of prematurity among infants born at gestational age <24 weeks: findings from a Swedish cohort Chatarina Löfqvist ,1,2,3 Shambhavi Sharma,3 Ann Hellström ,2 Hanna Gyllensten 1,3 ABSTRACT Objective Sweden has a long-standing tradition of actively managing infants born extremely preterm at 22– 23 weeks’ gestational age. This study analyses screening and treatment pathways for retinopathy of prematurity (ROP) in these infants, assessing costs and health outcomes to develop a model of direct healthcare costs. Method and analysis The cohort included all 399 infants born at 22–23 weeks in Sweden (2007–2018) who underwent ROP screening, recorded in the national ROP registry SWEDROP. A health economic model estimated costs based on three primary pathways: (1) no sightsaving treatment,(2) laser as initial treatment and (3) anti-vascular endothelial growth factor (anti-VEGF) as initial treatment. Pathways 2 and 3 were further divided into single and multiple treatments. Costs were calculated using screening frequency, treatment and neonatal care expenses. Register data were verified against medical records. An expanded model incorporated gestational age and comorbidities. Results In the basic model, 36% received laser (16 screenings on average; 32% required retreatment), while 7% received anti-VEGF injections (25 screenings; 69% required retreatment). The cost of screening and treating an infant with laser was Int$ 18 590, compared with Int$ 20 792 for anti-VEGF. The expanded models showed similar screening and treatment frequencies. Conclusion Despite similar overall costs, the higher screening burden in the anti-VEGF group (25 vs 16 screenings) raises concerns regarding cost-effectiveness and potential health impacts. Main limitations include the use of cost data from a single hospital, potential selection bias between treatment groups and limited precision in small subgroups. These findings lay the groundwork for future research on long-term health and cost outcomes in this vulnerable population. INTRODUCTION Retinopathy of prematurity (ROP) is a leading cause of childhood blindness globally and a major complication of extreme preterm birth, alongside other severe morbidities such as bronchopulmonary dysplasia, WHAT IS ALREADY KNOWN ON THIS TOPIC | ⇒ Laser and anti-vascular endothelial growth factor (anti-VEGF) are established treatments for retinopathy of prematurity (ROP), but comparative cost and screening burden data from real-world cohorts are limited.
⇒ Existing health-economic models in ROP have largely focused on screening strategies rather than treatment choice.
WHAT THIS STUDY ADDS | | --- | | ⇒ In this national cohort of infants born at 22

FAQs

What data and cohort were used to estimate ROP screening and treatment costs?

The analysis used all 399 Swedish infants born at 22–23 weeks (2007–2018) who underwent ROP screening, recorded in the national SWEDROP registry.

Which treatment pathways were compared in the cost model?

The model compared no sight-saving treatment, laser as initial treatment, and anti-VEGF as initial treatment, with laser/anti-VEGF further divided into single versus multiple treatments.

What were the key findings regarding screening burden and overall costs?

In the basic model, laser was associated with fewer screenings and retreatments than anti-VEGF. Although per-infant treatment costs were slightly lower for anti-VEGF, overall costs were similar or slightly higher, driven by a higher screening burden in the anti-VEGF group.

Sep 29, 2026

Upload by Sophia Brooks