Cost-effectiveness of eye care services in Zambia

ObjectiveTo estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia.MethodsPrimary 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.ResultsUtility 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.ConclusionIn spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions.

[1]  Paul Kind,et al.  How do Zimbabweans value health states? , 2003, Population health metrics.

[2]  K. Frick,et al.  Screening for refractive error and fitting with spectacles in rural and urban India: Cost-effectiveness , 2009, Ophthalmic epidemiology.

[3]  A. Kasuya.  EuroQol--a new facility for the measurement of health-related quality of life. , 1990, Health policy.

[4]  J. Stringer,et al.  Potential Cost-Effectiveness of Maternal and Infant Antiretroviral Interventions to Prevent Mother-to-Child Transmission During Breast-feeding , 2005, Journal of acquired immune deficiency syndromes.

[5]  D. Pascolini,et al.  Global estimates of visual impairment: 2010 , 2011, British Journal of Ophthalmology.

[6]  M. Lundström,et al.  Duration of self assessed benefit of cataract extraction: a long term study , 2005, British Journal of Ophthalmology.

[7]  C. Gilbert,et al.  Coverage of Hospital-based Cataract Surgery and Barriers to the Uptake of Surgery among Cataract Blind Persons in Nigeria: The Nigeria National Blindness and Visual Impairment Survey , 2012, Ophthalmic epidemiology.

[8]  K. Edmond,et al.  Costs of Meningitis Sequelae in Children in Dakar, Senegal , 2012, The Pediatric infectious disease journal.

[9]  R. Maini,et al.  Outcome of cataract surgery in Nigeria: visual acuity, autorefraction, and optimal intraocular lens powers--results from the Nigeria national survey. , 2011, Ophthalmology.

[10]  Michael Bach,et al.  Visual acuities "hand motion" and "counting fingers" can be quantified with the freiburg visual acuity test. , 2006, Investigative ophthalmology & visual science.

[11]  R. Harwood,et al.  Falls and health status in elderly women following first eye cataract surgery: an economic evaluation conducted alongside a randomised controlled trial , 2007, British Journal of Ophthalmology.

[12]  M. Sculpher,et al.  The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia , 2008, AIDS.

[13]  S. Lewallen,et al.  Willingness to pay for cataract surgery in two regions of Tanzania , 2005, British Journal of Ophthalmology.

[14]  R. Baltussen,et al.  Cost-Effectiveness of Pre-Exposure Prophylaxis (PrEP) in Preventing HIV-1 Infections in Rural Zambia: A Modeling Study , 2013, PloS one.

[15]  M. Jofre-Bonet,et al.  A comparison of the sensitivity of EQ-5D, SF-6D and TTO utility values to changes in vision and perceived visual function in patients with primary open-angle glaucoma , 2012, BMC Ophthalmology.

[16]  John E. Brazier,et al.  Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D , 2005, Quality of Life Research.

[17]  R. Kessler,et al.  Self-Reported Population Health: An International Perspective based on EQ-5D , 2014, Springer Netherlands.

[18]  L B Nash,et al.  Seeing is believing , 2013, BDJ.

[19]  C. Gudex,et al.  Measurement properties of the EQ-5D-5L compared to the EQ-5D-3L across eight patient groups: a multi-country study , 2012, Quality of Life Research.

[20]  John Brazier,et al.  A Review of Generic Preference-Based Measures of Health-Related Quality of Life in Visual Disorders , 2012, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[21]  U. Griffiths,et al.  Costs of Eye Care Services: Prospective Study from a Faith-based Hospital in Zambia , 2015, Ophthalmic epidemiology.

[22]  N. Tahhan,et al.  Utility and uncorrected refractive error. , 2013, Ophthalmology.

[23]  M. Carter,et al.  Global cost-effectiveness of cataract surgery. , 2007, Ophthalmology.

[24]  U. Stenevi,et al.  Cost‐effectiveness of cataract surgery: Method to assess cost‐effectiveness using registry data , 2002, Journal of cataract and refractive surgery.

[25]  G. Berdeaux,et al.  Modelling lifetime cost consequences of ReSTOR® in cataract surgery in four European countries , 2008, BMC ophthalmology.

[26]  L. Berthiaume,et al.  Wnt acylation: seeing is believing. , 2014, Nature chemical biology.

[27]  T. O. Tengs,et al.  A Meta-Analysis of Utility Estimates for HIV/AIDS , 2002, Medical decision making : an international journal of the Society for Medical Decision Making.

[28]  R. Rabin,et al.  EQ-SD: a measure of health status from the EuroQol Group , 2001, Annals of medicine.

[29]  K. Blanchet,et al.  Health systems analysis of eye care services in Zambia: evaluating progress towards VISION 2020 goals , 2014, BMC Health Services Research.

[30]  R. Harwood,et al.  Second-eye cataract surgery in elderly women: a cost-utility analysis conducted alongside a randomized controlled trial , 2010, Eye.

[31]  S. Fukuhara,et al.  Cost-utility analysis of cataract surgery in Japan: a probabilistic Markov modeling study , 2013, Japanese Journal of Ophthalmology.

[32]  Barry A Lester.  Comparing the cost-effectiveness of school eye screening versus a primary eye care model to provide refractive error services for children in India. , 2007, Community eye health.

[33]  S. Oke.  Cost analysis of cataract services by eye care providers in Nigeria. , 2007, Community eye health.

[34]  U. Griffiths,et al.  A Rapid Assessment of Avoidable Blindness in Southern Zambia , 2012, PloS one.

[35]  Gary C. Brown,et al.  Incremental cost-effectiveness of initial cataract surgery. , 2002, Ophthalmology.

[36]  A Briggs,et al.  The Distribution of Health Care Costs and Their Statistical Analysis for Economic Evaluation , 1998, Journal of health services research & policy.

[37]  G. Cesana,et al.  Comparing the performance of the standard EQ-5D 3L with the new version EQ-5D 5L in patients with chronic hepatic diseases , 2013, Quality of Life Research.

[38]  A. Torbica,et al.  Cost and reimbursement of cataract surgery in Europe: a cross-country comparison. , 2008, Health economics.

[39]  A. Fletcher,et al.  The Impact of Cataract Surgery on Health Related Quality of Life in Kenya, the Philippines, and Bangladesh , 2010, Ophthalmic epidemiology.

[40]  C. Gilbert,et al.  Presbyopic spectacle coverage, willingness to pay for near correction, and the impact of correcting uncorrected presbyopia in adults in Zanzibar, East Africa. , 2010, Investigative ophthalmology & visual science.

[41]  A. Williams.  EuroQol : a new facility for the measurement of health-related quality of life , 1990 .