Cost-Effectiveness Analysis of Cataract Surgery: A Global and Regional Analysis
Baltussen, Rob, Sylla, Mariame, Mariotti, Silvio P., Bulletin of the World Health Organization
Cataracts are a major cause of blindness and of severe visual impairment leading to bilateral blindness in an estimated 20 million people worldwide. In developing countries 50-90% of all blindness is caused by cataracts (1).
A cataract is a clouding of the lens of the eye that causes loss of vision. Although cataracts result from many conditions, the most frequent cause is the natural ageing process. Other causes include injury, chronic eye disease and other systemic diseases, such as diabetes (2). Cataracts can take from a few months to several years to develop and can affect both eyes at the same time, but they often develop at different rates. Sometimes the cataract stops developing in its early stages and vision is only slightly impaired. But if it continues to develop, vision is impaired, and treatment is necessary. Surgery to remove the opacified lens is the only effective treatment for cataracts. Neither diet nor medications have been shown to stop cataract formation. There are several possible approaches for the surgical extraction of cataracts. In this paper we evaluate the cost effectiveness of two different surgical procedures delivered to 50%, 80% or 95% of those who need surgery.
Cost-effectiveness analysis can be undertaken in many ways, and there have been several attempts to develop methodological guidelines to make results more comparable. WHO has developed a standardized set of methods and tools that can be used to analyse the societal costs and impact on the health of the population of current and new interventions at the same time (3, 4). The WHO-CHOICE (CHOosing Interventions that are Cost-Effective) project is intended to provide regularly updated databases on the costs and effects of a full range of interventions to promote health and prevent disease, and to cure and rehabilitate. Additional information on the project is shown in Box 1 (web version only, available at: http://www.who.int/bulletin). Adopting this standardized approach to generalized cost-effectiveness analysis allows comparison to be made among a range of interventions relating to cataracts as well as with intervention for other major health problems.
It would be desirable to evaluate all possible combinations of interventions for every country in the world. In the case of some of the larger countries, it would be desirable to evaluate these combinations at a subnational level. No country has yet been able to do this, and many countries do not have the technical capacity to evaluate even a few interventions. At the other extreme, global estimates of an intervention's cost effectiveness are of little use to any specific country.
This study provides information on the costs and health effects of cataract surgery at the subregional level in different parts of the world. Regions are grouped by geographical proximity and epidemiological similarity (Box 2). These can then be further contextualized to the country level.
Box 2. Regions used in this study Region Mortality stratum (a) Africa D Africa E Region of the A Americas Region of the B Americas Region of the D Americas Eastern Mediterranean B Region Eastern Mediterranean D Region European Region A European Region B European Region C South-East Asia Region B South-East Asia Region D Western Pacific Region A Western Pacific Region B Region Countries included Africa Algeria, Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Clad, Comoros, Equatorial, Guinea, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Togo Africa Botswana, Burundi, Central African Republic, Congo, Cole d'Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, South Africa, Swaziland, Uganda, United Republic of Tanzania, Zambia, Zimbabwe Region of the Canada, United States of America, Cuba Americas Region of the Antigua and Barbuda, Argentina, Bahamas, Americas Barbados, Belize, Brazil, Chile, Colombia, Costa Rica, Dominica, Dominican Republic, El Salvador, Grenada, Guyana, Honduras, Jamaica, Mexico, Panama, Paraguay, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Uruguay, Venezuela Region of the Bolivia, Ecuador, Guatemala, Haiti, Americas Nicaragua, Peru Eastern Mediterranean Bahrain, Cyprus, the Islamic Republic of Region Iran, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Tunisia, United Arab Emirates Eastern Mediterranean Afghanistan, Djibouti, Egypt, Iraq, Morocco, Region Pakistan, Somalia, Sudan, Yemen European Region Andorra, Austria, Belgium, Croatia, Czech Republic, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Slovenia, Spain, Sweden, Switzerland, United Kingdom European Region Albania, Armenia, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Georgia, Kyrgyzstan, Poland, Romania, Slovakia, Tajikistan, the Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Uzbekistan, Yugoslavia European Region Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine South-East Asia Region Indonesia, Sri Lanka, Thailand South-East Asia Region Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Maldives, Myanmar, Nepal Western Pacific Region Australia, Japan, Brunei Darussalam, New Zealand, Singapore Western Pacific Region Cambodia, China, Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Lao People's Democratic Republic, Marshall Islands, Malaysia, Mongolia, Nauru, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Solomon Islands, Tonga, Tuvalu, Vanuatu, Viet Nam (a) A = Regions wish very low adult mortality and low child mortality; B = low adult mortality and low child mortality; C = High adult it mortality and low child mortality; D = High adult mortality and high child mortality; E = Very high adult mortality and high child mortality. …