Cost-effectiveness of eye care services in Zambia

Abstract

Objective: To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia. Methods: Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were available from 77 and 41 patients who had received cataract surgery and spectacles, respectively. Costs were determined from patient interviews and micro-costing at the three health facilities. Utility values were gathered by administering the EQ-5D quality of life instrument immediately before and six months after cataract surgery or acquiring spectacles. A probabilistic state-transition model was used to generate cost-effectiveness estimates with uncertainty ranges.Results: Utility values significantly improved across the patient sample after cataract surgery and acquiring spectacles. Incremental costs per Quality Adjusted Life Years gained were US$ 259 for cataract surgery and US$ 375 for refractive error correction. The probabilities of the incremental cost-effectiveness ratios being below the Zambian gross national income per capita were 95% for both cataract surgery and refractive error correction. Conclusion: In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions.

Cataract Surgical Rate and Socioeconomics: A Global Study

“…The cost-effectiveness of cataract surgery in several countries was estimated in previous studies (Table). [77][78][79][80][81][82][83] In Japan, cataract surgery was associated with incremental costs of (¥) 551,513 (US$6920) and an incremental effectiveness of 3.38 QALYs per single cataract patient. 80 In the United Kingdom, a meta-analysis showed that second-eye surgery generated an additional 0.68 QALY with an incremental cost- effectiveness ratio of £1964 per QALY gained.…”

“…Furthermore, initial cataract surgery yielded an extraordinary 4567% financial return on investment (ROI) over a 13-year period. 78,82 Brown et al 84 have also demonstrated that the financial ROI for direct ophthalmic expenditures for cataract surgery to be approximately 4500%. This data suggests that significant benefits and returns can be derived from increased spending on cataract surgery.…”

Infectious disease and health systems modelling for local decision making to control neglected tropical diseases

“…Of course, although data analysis/synthesis and modelling can address the effectiveness aspects of these questions, economic evaluation is required to address the cost aspects. This is a major undertaking in itself, and much of what we have written about modelling could also be written about economic evaluation: it is context sensitive and under-resourced, so that supra-national results are having to be used to make local decisions (for example,[ 22 ]).…”

Are presbyopes willing to pay for spectacles? A Cross-sectional study’’

“…According to Patel et al a high proportion of people (69%) especially men were able to afford spectacles at a price that covered including the shipping cost [1]. Similarly, the mean cost of spectacle in different states of Zambia ranges from US$ 4.0-20.0 [16].…”