The development of a public optometry system in Mozambique: a Cost Benefit Analysis.

Stephen Thompson,James Loughman,Geoff Harris,Jorge Ferrão,Kovin Naidoo,Luigi Bilotto

doi:10.1186/1472-6963-14-422

Abstract

BackgroundThe economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. The nature of the MEP programme provides the opportunity to determine, using Cost Benefit Analysis (CBA), whether investing in the establishment and delivery of a comprehensive system for optometry human resource development and public sector deployment is economically justifiable for Lusophone Africa.MethodsA CBA methodology was applied across the period 2009–2049. Costs associated with establishing and operating a school of optometry, and a programme to address uncorrected refractive error, were included. Benefits were calculated using a human capital approach to valuing sight. Disability weightings from the Global Burden of Disease study were applied. Costs were subtracted from benefits to provide the net societal benefit, which was discounted to provide the net present value using a 3% discount rate.ResultsUsing the most recently published disability weightings, the potential exists, through the correction of URE in 24.3 million potentially economically productive persons, to achieve a net present value societal benefit of up to $1.1 billion by 2049, at a Benefit-Cost ratio of 14:1. When CBA assumptions are varied as part of the sensitivity analysis, the results suggest the societal benefit could lie in the range of $649 million to $9.6 billion by 2049.ConclusionThis study demonstrates that a programme designed to address the burden of refractive error in Mozambique is economically justifiable in terms of the increased productivity that would result due to its implementation.

Highlights

The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem
Sensitivity analysis Methodological sensitivity to the discount rate was tested, and the results indicated that the outcome of the study did not change until a 72% discount rate was applied, at which point the net present value of societal benefits for new Disability weighting (DW) became negative
The Vision Loss Expert Group (VLEG), comprising of leading ophthalmologists and optometrists, has expressed concern at how low the new DWs are compared to the previous weighting, noting variations in the formulation of the lay survey questions pertaining to different health conditions

Summary

Introduction

The economic burden of uncorrected refractive error (URE) is thought to be high in Mozambique, largely as a consequence of the lack of resources and systems to tackle this largely avoidable problem. The Mozambique Eyecare Project (MEP) has established the first optometry training and human resource deployment initiative to address the burden of URE in Lusophone Africa. Uncorrected refractive error (URE) is the leading global cause of low vision, and causes almost half of all visual impairment (VI) [1]. It is recognised as a priority public health condition by a joint programme of the World Health Organization and the International Agency for the Prevention of Blindness under the global initiative, VISION 2020 [2].

Methods

Results

Discussion

Conclusion