Cost-effectiveness of public-funded options for cataract surgery in Mysore, India.

Abstract

The 8.9 million blind people in India account for 24% of blindness worldwide, and 3.8 million people become blind from cataracts every year in India. In this study, the cost-effectiveness of public-funded options for delivering cataract surgery was assessed in one district in India, Mysore, Karnataka State. Three types of delivery of cataract surgery were studied: mobile government camps, walk-in services at a state medical college hospital, and patients transported from satellite clinics to a nongovernmental hospital. Outcomes were assessed in a systematic sample of patients operated on in 1996–1997 by follow up at home, and average costs by provider were derived from actual expenditures during the year. Almost half the patients operated on in government camps were dissatisfied with the outcome (34/70, 49%). More than one third were blind in the operated eye after the surgery (25/70, 36%). User satisfaction was higher with other providers (medical college hospital 82%; nongovernment hospital 85%) and fewer patients remained blind. Camps were a low-cost option, but the poor outcomes reduced their cost-effectiveness to US $97 per patient. The state medical college hospital was least cost-effective, at US $176 per patient, and the nongovernmental hospital was the most cost-effective at US $54 per patient. The authors concluded that the government of India should review its policy for government camp surgery and consider alternatives, such as transporting patients to better permanent facilities. India and other developing countries should monitor outcomes in cataract surgery programs, as well as throughput.—Nancy J. Newman