Cost Of Cataract Surgery Research Articles

Cost of cataract surgery at a provincial hospital in South Africa

Cost of cataract surgery at a provincial hospital in South Africa

Application Of Activity-Based Costing Method in The Eestimate of Cataract Surgery Cost

Objective: Hospital managers need to have accurate information about actual costs to make efficient and effective decisions. Activity-based costing (ABC) is put forward as an alternative, more accurate costing method to calculate the cost of medical treatment. The objective of this paper is the application of an activity-based method to estimate the cost of cataract surgery in an ophthalmic hospital. Methods: The present descriptive-analytical study was carried out at an ophthalmic hospital, in February and March of 2021, in Iran. Surgical operations for cataracts were considered. The required data were collected through conducting interviews with experts and relevant units, direct observation of activities, analysis of documents in the financial department, and the hospital information system (HIS) and financial software system of the hospital. The cost of surgical operations was estimated by activity-based costing (ABC). Results: According to the findings, the amount and the share of the total costs of the activities identified in the main centers were as follows: human resources 54.24% of the total cost of cataract surgery which is the highest share of surgery costs; the cost of consumables was 32.57% of the total cost of cataract surgery is the second share of surgery costs. Conclusions: The research results showed that in this regard administrators should design and implement a comprehensive operational planning system in the hospital.

To investigate the individual and household-level factors influencing the willingness to pay for cataract surgery among patients aged 50 years and older in rural China: a cross-sectional study

ObjectivesTo investigate the factors influencing the willingness to pay (WTP) for cataract surgery among patients aged 50 years and older in rural China at both individual and household levels.DesignA cross-sectional...

Cost Utility and Value of Information Analysis of Femtosecond Laser–Assisted Cataract Surgery

The efficacy and safety of femtosecond laser-assisted cataract surgery is well documented. An important requirement for decision makers is the evaluation of the cost-effectiveness of femtosecond laser-assisted cataract surgery (FLACS) over a sufficiently long horizon. Evaluating the cost-effectiveness of this treatment was a preplanned secondary objective of the Economic Evaluation of Femtosecond Laser Assisted Cataract Surgery (FEMCAT) trial. To estimate the cost utility of FLACS compared with phacoemulsification cataract surgery (PCS) on a 12-month time horizon. This multicenter randomized clinical trial compared FLACS with PCS in parallel groups. All FLACS procedures were performed using the CATALYS precision system. Participants were recruited and treated in ambulatory surgery settings in 5 university-hospital centers in France. All consecutive patients eligible for a unilateral or bilateral cataract surgery 22 years or older with written informed consent were included. Data were collected from October 2013 to October 2018, and data were analyzed from January 2020 to June 2022. FLACS or PCS. Utility was measured through the Health Utility Index questionnaire. Costs of cataract surgery were estimated by microcosting. All inpatient and outpatient costs were collected from the French National Health Data System. Of 870 randomized patients, 543 (62.4%) were female, and the mean (SD) age at surgery was 72.3 (8.6) years. A total of 440 patients were randomized to receive FLACS and 430 to receive PCS; the rate of bilateral surgery was 63.3% (551 of 870). The mean (SD) costs of cataract surgery were €1124.0 (€162.2; US $1235) for FLACS and €565.5 (€61.4; US $621) for PCS. The total mean (SD) cost of care at 12 months was €7085 (€6700; US $7787) in participants treated with FLACS and €6502 (€7323; US $7146) in participants treated with PCS. FLACS yielded a mean (SD) of 0.788 (0.009) quality-adjusted life-years (QALYs), and PCS yielded 0.792 (0.009) QALYs. The difference in mean costs was €545.9 (95% CI, -434.1 to 1525.8; US $600), and the difference in QALYs was -0.004 (95% CI, -0.028 to 0.021). The incremental cost-effectiveness ratio (ICER) was -€136 476 (US $150 000) per QALY. The cost-effectiveness probability of FLACS compared with PCS was 15.7% for a cost-effectiveness threshold of €30 000 (US $32 973) per QALY. At this threshold, the expected value of perfect information was €246 139 079 (US $270 530 231). The ICER of FLACS compared with PCS was not within the $50 000 to $100 000 per QALY range frequently cited as cost-effective. Additional research and development on FLACS is needed to improve its effectiveness and lower its price. ClinicalTrials.gov Identifier: NCT01982006.

Impact of the value driven outcomes program among cataract surgery patients in Singapore: an interrupted time series analysis

BackgroundHealthcare cost is increasing rapidly in Singapore. Moving towards a value-based healthcare framework enables a sustainable health system. The National University Hospital (NUH) implemented the Value Driven Outcome (VDO) Program for cataract surgery due to its high volume and cost variability. We aimed to evaluate the association between VDO program implementation and costs and quality outcomes for cataract surgery in NUH.MethodsWe conducted an interrupted time-series analysis for cataract surgery episodes between January 2015 and December 2018. Using segmented linear regression models, we estimate the changes in levels and trends of cost and quality outcomes post-program implementation. We adjusted for autoregression and various confounders.ResultsFollowing VDO program implementation, the total cost of cataract surgery had a significantly decreased by $327.23 (95% CI: -$421.04 to -$233.43; p < 0.01) and the trend significantly decreased by $13.75 per month (95% CI: -$23.19 to -$4.30 per month; p < 0.01). There was a small improvement in the combined quality outcome score (0.028, 95% CI: 0.016 to 0.040; p < 0.01), but the trend remained unchanged.ConclusionThe VDO program was associated with a reduction in cost without compromising on quality outcomes. The program provides a structured methodology to measure performances, and through these data, initiatives were implemented to improve value. There are benefits to providing a data reporting system to physicians to understand actual care costs and quality outcomes achieved by individual patients with defined clinical conditions.

Cataract surgery knowledge, awareness, and misconceptions among Tabuk city&amp;apos;s adult population: a cross-sectional survey

Objective: This study aimed to determine the degree of knowledge, awareness, and misconceptions about cataract surgery among the adult population in Tabuk city, Saudi Arabia. Methods: This was a cross-sectional survey study consisting of 692 participants. This study design allows the collection of data from a representative sample of the adult population in Tabuk city, Saudi Arabia. Results: Around 68.6% participants had heard about cataract surgery; where family and friends were the most frequent source of knowledge (42.63%). The participants&amp;apos; knowledge about cataract surgery was inadequate, as 47.5% were not sure. The awareness of the participants about the availability of cataract surgery facilities (54.8%) and the cost of cataract surgery (64.6%) in Tabuk city showed adequate information. Majority of the participants showed agreement that cataract surgery could significantly improve one\&amp;apos;s quality of life (64%) and early detection and treatment of cataracts can prevent further vision loss (76.3%). Further, age group between 18-30 years, males and bachelor, master and doctoral degree holders demonstrated adequate knowledge and awareness of cataracts. Conclusion: The participants&amp;apos; knowledge of government policies or activities supporting access to cataract surgery in Tabuk city was lacking. Future studies should concentrate on raising cataract awareness. Patients should be informed about risk factors, complications, treatment options, cataract surgery complications, and regular follow-ups. Early detection and treatment of this problem would be easier with routine eye exams.

Description of day case costs and tariffs of cataract surgery from a sample of nine European countries

BackgroundThe lack of transparency in the methodology of unit cost estimation and the usage of confidential or undisclosed information prevents cost comparisons and makes the transferability of the results across countries difficult. The objective of this article is to compare the methodologies used in the estimation of the cost of a day case cataract extirpation that are described in the official and publicly available sources and to study how these translate into different unit cost estimates.MethodsA literature review was conducted to identify the main sources of unit costs of cataract extirpation. A semi-structured questionnaire to obtain information on national costing methodologies was developed and sent to consortium partners in nine European countries. Additionally, publicly available sources of unit cost of cataract surgery in those countries included in the European Healthcare and Social Cost Database (EU HCSCD) were analysed.ResultsThe findings showed a considerable diversity across countries on unit costs varying from 432.5€ in Poland (minor degree of severity) to 3411.96€ in Portugal (major degree of severity). In addition, differences were found in the year of cost publication and on the level of detail of different types of cataract surgery. The unit of activity were Diagnosis-Related Groups in all countries except Slovenia. All unit costs include direct costs and variable overheads (except Germany where nursing costs are financed separately). Differences were identified in the type of fixed overheads included in unit costs. Methodological documents explaining the identification, measurement and evaluation of resources included in the unit costs, as well as use of appropriate cost drivers are publicly available only in England, Portugal and Sweden.ConclusionsWe can conclude that while unit costs of cataract extirpation are publicly available, the information on methodological aspects is scarce. This appears to pose a significant problem for cross-country comparisons of costs and transferability of results from one country to another.

Health Literacy on Cataract and Its Treatment Options Among Patients with Operable Cataract: A Cross Sectional Study from Moradabad (India)

Purpose: To investigate the awareness of cataract disease and treatment options among patients with operable cataract. Methods: Participants were selected by means of eye disease screenings throughout Moradabad district. A pre-tested structured, content-validated questionnaire, translated in Hindi, was used for seeking study-related information and consisted of three sections: 1) Socio-demographic characteristics, 2) Knowledge and 3) Attitude of patients regarding cataract and its treatment. Questionnaire was administered by a trained interviewer after it was determined that the patient needed cataract surgery. Results: A total of 192 participants were interviewed. Of all, 98.5% patients were aware of their condition. Surgery as a treatment for cataract was known to 57.6% respondents. 50.2% patients knew that during surgery, natural lens was replaced with an artificial lens. 89.2% believed that the cost of cataract surgery prevented people from seeking interventions, while 31.5% deemed it unaffordable. An acquaintance getting operated was the motivating factor for 47.3% patients. The principal barriers in seeking cataract treatment were found to be lack of accessibility and fear of pain in by 98% and 65.5% of patients respectively. Conclusion: Our study highlighted that majority of the respondents were aware of cataract as a disease, but the potential barriers preventing them from seeking treatment were accessibility, cost of surgery and personal belief. This study emphasizes the need for increasing the uptake of cataract services in the North Indian community. We apprehend that focused propagation of knowledge and communication will successfully enhance demand for cataract surgical services.

Implanting trabecular meshwork bypass stents during cataract surgery cost effective in the USA

Implanting trabecular meshwork bypass stents during cataract surgery cost effective in the USA

Female Clients Satisfaction towards Primary and Secondary Eye Health Facilities and Cost of Eye Care in Nepal.

In Nepal, females suffer from disproportionately higher burden of blindness and vision impairment with low access to eye care. The available knowledge is inadequate to address the issues related to gender and generate information to reduce the gender disparity. The aim of this study was to determine female clients' satisfaction with services at eye facilities in Nepal and to estimate the cost of cataract surgery. Exit interviews were conducted in 2018 with 308 female clients from eight facilities in five districts. Face to face interviews were conducted using a pretested semi-structured questionnaire adopted from the midterm review of Vision 2020. The mean age of participants was 54±17 years. Ninety seven percent (97%) of the participants reported that they received service as per their expectation and were satisfied with the service of the facilities. Major factors for satisfaction were: thorough eye examination (54%), behavior of health staff (40%), and cleanliness of health facility (39%). Another eighty percent (80%) of the participants mentioned that they would recommend or return to the same facility. Fifteen percent of the participants perceived that they faced problems at the eye facility because of their gender. Around three quarters (73%) paid health expenses from their pocket. Most (83%) of the participants rated user fees as either reasonable or inexpensive. The majority of participants reported receiving service as expected and willingness to return to the same eye health facility for future consultation. However, most participants had to pay the health care expenses out-of-pocket.

Cost-Benefit Analysis of Single versus Repeated Use of Single-Use Devices in Cataract Surgery.

PurposeTo estimate the net cost effect associated with the real-world practice of repeated use of designated single-use medical devices (SUDs) versus their proper single use in cataract surgery in Greece.DesignA cost-benefit analysis model was constructed in the form of a decision tree.MethodsA digital expert panel was assembled in order to estimate the probabilities of intraoperative and postoperative complications associated with single and repeated use of SUDs. Unit costs for the management of each complication were obtained from the official Greek bulletins. A Monte Carlo-type sensitivity analysis was performed to assess the robustness of the results.ResultsBased on the probabilities of complications attained from the expert panel, repeated use of SUDs is associated with a higher chance of complications compared to single use, which results in higher cost of complication management. Under the healthcare sector perspective, the total expected cost per cataract surgery is 1,403.98€ (1,244.20€ the initial cost of cataract surgery plus 159.78€ the cost of adverse events) in the case of single use, while for repeated use the total cost is 1,486.29€ (1,146.86€ + 339.43€, respectively) and, thus, repeated use of SUDs in cataract surgery results in 82.31€ higher expected cost per patient compared to their single use. Moreover, the societal perspective analysis indicated even higher additional costs in the case of SUD reuse (108.24€).ConclusionRepeated use of SUDs in cataract surgery is not appropriate, it jeopardizes patient safety and carries a legal liability for the reuser. The present study, which is the first to attach a monetary value to the common yet questionable practice of SUD reuse, shows that it is not cost beneficial. Therefore, it is expected that the results will have implications in policy formulations to improve the delivery of cataract healthcare.

Willingness to pay for cataract surgery in baiyin district, northwestern China

ABSTRACT Purpose To investigate willingness to pay for cataract surgery, and its associations, in Northwestern China. Methods Four hundred thirty-eight persons aged 50 years and above, diagnosed with cataract indicated for surgery, identified in an outreach screening program were included. Subjects were offered a willingness-to-pay interview for the maximal amount that the subjects would be willing to pay for a cataract surgery. Age, gender, literacy, education level, occupation, and annual household income were recorded. Results Among 328 (74.9%) subjects who completed the interview, 197 (60.1%) participants were willing to pay something for the cataract surgery (mean, 902.9 ± 856.7 renminbi[RMB], [US$ 145 ± 137]; median, 500RMB, US$ 78). Individuals with presenting visual acuity (PVA) in the worse eye ≤6/60 (OR: 2.1, 95% CI: 1.3–3.2) and a high annual household incomes (OR: 2.0, 95% CI: 0.9–4.6) were likely to be willing to pay for the surgery, as revealed in the regression models. Willingness to pay any amount for cataract surgery was more likely among literate persons (OR: 1.5, 95% CI: 1.0–2.4) and persons with non-agricultural occupation (OR: 1.8, 95% CI: 1.0–3.2). Conclusions The amount that subjects were willing to pay is significantly less than the current cost of cataract surgery (5000 RMB, US$320) in the area. Providing low-cost cataract surgery to patients in a financially sustainable manner is important to increase uptake of cataract surgery among rural residents in Northwest China.

Who benefits most from extending financial protection for cataract surgery in Vietnam? An extended cost-effectiveness analysis of small incision surgery.

Treatment costs remain a barrier for having timely cataract surgery in Vietnam, particularly for females and the poor, despite significant progress in achieving universal health coverage (UHC). This study evaluated the potential impact, on health and financial protection, of eliminating medical and non-medical out-of-pocket costs associated with cataract surgery. An extended cost-effectiveness analysis (ECEA) was conducted with a societal perspective. The ECEA modelled how many more disability-adjusted life years (DALYs) and cases of catastrophic health expenditure (CHE) and medical impoverishment could be averted across income quintiles and between males and females. Two programmes were evaluated: (1) eliminating medical out-of-pocket costs for small incision cataract surgery and (2) Programme A plus a voucher programme covering non-medical out-of-pocket costs. Compared with current, the incremental cost per year of Programme A was estimated to be $833 396 and $1 641 835 for Programme B, each representing <0.01% of total health care spending in 2016. Males and females in the richest income quintiles would avert more DALYs than those in the poorest quintiles. For both programmes, most cases of CHE would be averted by individuals in the poorest income quintile. Programme B would avert the most CHE cases overall and females would have a greater share of benefits. All cases of impoverishing medical expenditure would be averted by individuals in the poorest quintile (A: 115 cases and B: 493 cases) for both programmes. The cost to avert each case of CHE with Programme A ranged from $67 to $292 and $100 to $232 for Programme B. We found a pro-rich health distribution and a pro-poor CHE distribution associated with eliminating out-of-pocket costs of cataract surgery in Vietnam. A programme that addressed both medical and non-medical out-of-pocket costs could have the greatest impact on improving financial protection in this population, particularly among the poorest income quintiles and for females. This study supports the concordance between the objectives of UHC and gender equity.

Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh.

Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.

A Sustainable Model For Delivering High-Quality, Efficient Cataract Surgery In Southern India.

Cataracts are a leading cause of reversible blindness in India, where millions of people can be effectively treated for this condition with surgery. The Aravind Eye Care System in southern India developed an efficient system for delivering high-quality and low-cost cataract surgery. We provide a detailed accounting of costs of cataract surgery at the system and a cost-utility analysis. Total costs per operation were US$120, or $195 per quality-adjusted life-year gained. Using these data and population-based estimates of cataract prevalence, we calculate that eliminating cataract-related blindness and low vision in India would cost $2.6billion and would yield a net societal benefit of $13.5billion. Factors contributing to the highly cost-effective care at the Aravind Eye Care System include the domestic manufacturing of supplies, the use of a specialized workforce and standardized protocols, and the presence of few regulatory hurdles. Lessons learned from the system can help improve the delivery of cataract surgery and other ambulatory care surgeries in India and abroad.

Cost-Utility Analysis of Cataract Surgery in Advanced Glaucoma Patients.

To assess the cost-effectiveness of cataract surgery in advanced glaucoma (AG) patients. A total of 93 patients with AG who underwent cataract surgeries were collected prospectively from June 2010 through June 2013 in Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, and were followed up for at least 3 months. A standard phacoemulsification technique was used to remove cataract(s). No complications occurred intraoperatively or postoperatively. Costs associated with surgery were recorded. Utility values of cataract surgery were obtained by using time trade-off method. Quality-adjusted life-years (QALYs) were calculated using the patients' life expectancy at a 3% discounted rate. Incremental cost-utility analysis was performed (compared with no treatment) by calculating the incremental cost-effectiveness ratio (ICER), that is, the mean incremental cost for each QALY. The bootstrap method was used for statistical analysis, and sensitivity analyses were performed to test robustness of the results. The mean incremental cost of cataract surgery was 9876 Chinese yuan (CNY) [1593 US dollar (USD)] [95% confidence interval (CI), 9144-10,570 CNY (1475-1705 USD)].The mean additional QALYs gained were 2.20 (95% CI, 1.85-2.54), and the incremental cost for each additional QALY was 4508 CNY (727 USD) [95% CI, 3890-5234 CNY (627-844 USD)], far lower than the per capita annual disposable income in Shanghai, 40,188 CNY (6482 USD). For AG patients, cataract surgery does help obtain more QALYs and was highly cost effective.

Complications of Cataract Surgery in Iran: Trend from 2006 to 2010

ABSTRACTPurpose: To determine intraoperative complications of cataract surgery over the period 2006 to 2010.Methods: In this cross-sectional study, 106 of 272 cataract surgical centers in Iran were selected through multistage random cluster sampling from all provinces. In each province, the selected number of centers was proportionate to the number of cataract surgeries, and in each center, the selected number of charts was proportionate to the center’s number of cataract surgeries, from which we retrieved intraoperative complications.Results: The prevalence of intraoperative complications of cataract surgery was 5.04% (95% confidence interval, CI, 3.53–6.54%) in 2006, which decreased significantly to 3.44% (95% CI 1.84–5.04%) in 2010. The most common complication was posterior capsular rupture/vitreous loss which decreased from 4.29% (95% CI 2.93–5.66%) in 2006 to 2.81% (95% CI 1.3–4.31%) in 2010. The next most common complication was suprachoroidal hemorrhage at 0.56% (95% CI 0.25–0.87%) in 2006 and 0.46% (95% CI 0.3–0.62%) in 2010. The least common complication concerned intraocular lens (IOL)-drop. Complications were seen most with lensectomy, while phacoemulsification caused the least complications. Mean hospitalization time in uncomplicated cases was 0.59 days (95% CI 0.58–0.61 days) and in complicated cases 1.14 days (95% CI 1.07–1.20 days; p < 0.001).Conclusion: Complications of cataract surgery in Iran had a decreasing trend during 2006–2010. However, results from 2010 indicate that cataract surgical complications still need to be focused on. Hospitalization was longer for cases with complications, and further reducing this could help decrease costs of cataract surgery.

Direct non-medical costs double the total direct costs to patients undergoing cataract surgery in Zamfara state, Northern Nigeria: a case series.

BackgroundCost is frequently reported as a barrier to cataract surgery, but few studies have reported costs of accessing surgery in Africa. The purpose of this prospective, facility based study was to compare direct non-medical cost with total direct cost of cataract surgery to patients, and to assess how money was found to cover costs.MethodsParticipants were those aged 17 years and above attending their first post-operative visit after first eye, subsidised, day case cataract surgery. Systematic random sampling was used to select participants who were interviewed to obtain data on socio-demographic details, and on expenditure during the assessment visit, the surgical visit, and the first follow-up visit. Costs were a) direct medical costs (patients’ costs for registration, investigations, surgery, medication), and b) direct non-medical costs (patients’ and escorts’ costs for transport, accommodation, meals). The source of funds to pay for the services received was also assessed.ResultsAlmost two thirds (63%) of the 104 participants were men. The mean age of men was 64 (±12.5) years, being 63 (±12.9) years for women. All men were married and 35% of women were widows. 84% of men were household heads compared with 6% of women. The median total direct cost for all visits by all participants was N8,245 (US$51), being higher for men than women (N9,020; US$56 and N7,620; US$47) (p < 0.09) respectively. Direct non-medical cost constituted 49% of total direct cost. 92% of participants had adequate money to pay, but 8% had to sell possessions to raise the money. 20% of unmarried women sold possessions or took out a loan.ConclusionDespite the subsidy, cost is still likely to be a barrier to accessing cataract surgery, as the total direct costs represented at least 50 days income for 70% of the local population. Provision of transport would reduce direct non-medical costs.

Cost of Intraocular Lens versus Contact Lens Treatment after Unilateral Congenital Cataract Surgery in the Infant Aphakia Treatment Study at Age 5 Years

To analyze differences in the cost of treatment for infants randomized to primary intraocular lens (IOL) implantation versus optical correction with a contact lens (CL) after unilateral cataract surgery in the Infant Aphakia Treatment Study (IATS). Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid reimbursement data as well as actual costs of supplies used during the study, adjusted for inflation. The IATS is a multicenter (n= 12), randomized clinical trial comparing the optical treatment of aphakia with either primary IOL implantation (n= 57) or CL correction (n= 57) in 114 infants with unilateral congenital cataract. One hundred fourteen infants underwent unilateral cataract surgery and were either corrected optically by primary IOL implantation at the time of surgery or were corrected with a CL after surgery. The mean cost of cataract surgery and all additional surgeries, examinations, and supplies used up to 5 years of age. The 5-year treatment cost of an infant with a unilateral congenital cataract corrected optically with an IOL was $27 090 versus $25 331 for a patient treated with a CL after initial cataract surgery. The total cost of supplies was $3204 in the IOL group versus $7728 in the CL group. Unilateral cataract surgery in infancy coupled with primary IOL implantation is approximately 7% more expensive than aphakia and CL correction. Patient costs are more than double with CL versus IOL treatment.

Cataract surgery in Southern Ethiopia: distribution, rates and determinants of service provision.

BackgroundCataract is the leading cause of blindness worldwide, with the greatest burden found in low-income countries. Cataract surgery is a curative and cost-effective intervention. Despite major non-governmental organization (NGO) support, the cataract surgery performed in Southern Region, Ethiopia is currently insufficient to address the need. We analyzed the distribution, productivity, cost and determinants of cataract surgery services.MethodsConfidential interviews were conducted with all eye surgeons (Ophthalmologists & Non-Physician Cataract Surgeons [NPCS]) in Southern Region using semi-structured questionnaires. Eye care project managers were interviewed using open-ended qualitative questionnaires. All eye units were visited. Information on resources, costs, and the rates and determinants of surgical output were collected.ResultsCataract surgery provision is uneven across Southern Region: 66% of the units are within 200 km of the regional capital. Surgeon to population ratios varied widely from 1:70,000 in the capital to no service provision in areas containing 7 million people. The Cataract Surgical Rate (CSR) in 2010 was 406 operations/million/year with zonal CSRs ranging between 204 and 1349. Average number of surgeries performed was 374 operations/surgeon/year. Ophthalmologists and NPCS performed a mean of 682 and 280 cataract operations/surgeon/year, respectively (p = 0.03). Resources are underutilized, at 56% of capacity. Community awareness programs were associated with increased activity (p = 0.009). Several factors were associated with increased surgeon productivity (p < 0.05): working for >2 years, working in a NGO/private clinic, working in an urban unit, having a unit manger, conducting outreach programs and a satisfactory work environment. The average cost of cataract surgery in 2010 was US$141.6 (Range: US$37.6–312.6). Units received >70% of their consumables from NGOs. Mangers identified poor staff motivation, community awareness and limited government support as major challenges.ConclusionsThe uneven distribution of infrastructure and personnel, underutilization by the community and inadequate attention and support from the government are limiting cataract surgery service delivery in Southern Ethiopia. Improved human resource management and implementing community-oriented strategies may help increase surgical output and achieve the “Vision 2020: The Right to Sight” targets for treating avoidable blindness.