Modelling the Burden and Cost-Effectiveness of School-Based Vision Screening Programs in Nigeria’s Universal Basic Education System

School-based vision screening is widely recommended as a strategy for detecting refractive errors and other visual conditions affecting educational performance, yet evidence on the cost-effectiveness of such programs in the Nigerian Universal Basic Education (UBE) context is entirely absent. This study models the burden of uncorrected visual impairment among primary school children and evaluates the cost-effectiveness of three school vision screening delivery models in Nigeria. A decision analytic modeling framework, specifically a Markov microsimulation model, will be constructed using epidemiological data from a nationally representative sample of 4,000 primary school children drawn from 10 states across all six geopolitical zones. Three screening delivery models will be compared: teacher-led screening, optometrist-led screening, and a hybrid telemedicine-based model. Model parameters will include prevalence of uncorrected refractive error, sensitivity and specificity of each screening approach, spectacle uptake rates, quality-adjusted life year gains, and program costs. Incremental cost-effectiveness ratios will be calculated using a threshold of one times Nigeria's GDP per capita. The model will produce robust estimates of the number needed to screen and the cost per corrected child across ecological settings. Findings will be submitted to the Universal Basic Education Commission and the Federal Ministry of Health as evidence for national policy on school vision care. Keywords: cost-effectiveness, school vision screening, Universal Basic Education, Nigeria, Markov model