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

Background. In India 3.8 million people become blind due to cataracts every year. We assessed the cost-effectiveness of public-funded options for delivering cataract surgery in Mysore, Karnataka State, India. Methods. Three types of delivery of cataract surgery were studied: mobile government camps, walk-in services at a state medical college hospital, and patients transported in from satellite clinics to a non-governmental hospital. We assessed outcomes in a systematic sample of patients operated on in 1996-97 by follow-up at home; average costs by provider derived from actual expenditures during the year. Findings. Almost half the patients operated on in government camps were dissatisfied with the outcome (34/70, 49 [95 CI 36-61]). More than one third were blind in the operated eye (25/70, 36 [25-48]). User satisfaction was higher with other providers (medical college hospital 82 [63-94]; non-government hospital 85 [72-93]), and fewer patients remained blind. Camps were a low-cost option, but the poor outcomes reduced their cost-effectiveness to US97 per patient. The state medical college hospital was least cost-effective, at US176 per patient, and the non-governmental hospital was the most cost-effective at US54 per patient. Interpretation. 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 programmes, as well as throughput.