Cost utility analysis of cataract surgeries performed in rural centers through national program for control of blindness in the district of Puducherry, south India

Session Details

Session Title: Orbis Free Paper session

Session Date/Time: Monday 15/09/2014 | 11:45-12:45

Paper Time: 11:57

Venue: Capital Suite 14 (Level 3)

First Author: : K.Sharma INDIA

Co Author(s): :    J. Bosco Arokiam   A. Valli   S. Rene   G. Behera   S. Manzoor   K. Bosco

Abstract Details

Purpose:

Health care economics evaluates costs and consequences of a particular health care intervention. Cost effective, cost benefit and cost utility analysis are techniques used in assessment of economic evaluation of health expenditures. Cost utility analysis is the preferred methodology as the technique incorporates measured individual outcome to a particular therapy. Cost utility analysis uses quality adjusted life as the unit of measurement (QALY). The purpose of this study is to evaluate the quality of life improvement (QALY) following cataract surgery in rural surgical camp centers in the District of Puducherry, India.

Setting:

Puducherry, south India

Methods:

Target respondents were the patients who presented at primary health center with BCVA < 6/60 and vision loss due to cataract and willing to undergo cataract surgery in the camp center. All primary health centers are located in rural areas and identified as surgical camp centers for cataract surgeries by the district administration. Surgeries were performed under the aegis of National Program for Control of Blindness, as a reach out program in control of blindness. Cost utility analysis of cataract surgeries performed in rural centers was studied comparing the expenditure incurred by the Government to the quality of life gained by the patient using utility indices. This is a prospective study conducted at five primary health centers located in rural areas of the District of Puducherry, India. Cost utility model was developed based on Health utility attributes. This study considered - Vision (b1), ambulation (b2), pain (b3), self care (b4), usual activities (b5), economic productivity (b6) and emotional status (b7) as the preferred attributes. Each of the attributes was scored on a scale of 1 to 6 with points ranging from 1.0 which denotes excellent utility, to 0.00 which denotes poor utility. Hence final utility scoring done based on the Formula: U=1.06 (b1 x b2x b3x b4x b5x b6x b7)-0.06, U is the final utility score. Standard error 1.06 and sampling error of 0.06 incorporated in the model. Mode of data collection was by standard questionnaires. Utility scores are measured pre-operative, post operative first day, first week, weekly thereafter for six weeks and monthly for three months. Cumulative utility scores between pre-operative and third month post operative reflects the utility gains following cataract surgery. Cost factor per surgery calculated at Rupees INR 750/= (Euro-8.82) per patient.

Results:

150 patients included in the study. 54% were males and 46% were females. Mean age of patients 63.21 ±8.26years. Patients Categorized into three groups based on initial BCVA in the better eye. Group I had initial visual acuity ranging between perception of light to 2/60,Group II between 3/60 to 4/60 and Group III between 5/60 to 6/60. 50 patients included in each group. Utility scores for individuals were measured from pre-operative state to 3 month post-operative. Difference in utility scores was analyzed by paired t-test.Group I- pre-op:0.063±0.109, post-op:0.827±0.266(p<0.001), Group II – pre-op:0.108±0.143, post-op:-0.721±0.255(p<0.001), Group III- pre-op:0.210±0.140, post-op:0.680±0.206(p<0.001) Mean utility score difference was highest in Group I patients 0.76, followed by Group II 0.62, Group III being the lowest at 0.47. Group I with poor Pre-operative utility indices benefited maximum following surgery.

Conclusions:

Vision is the fundamental essence in quality of life. Improvement in vision improves the quality of life. Vision, ambulation, pain, self care, usual activities, economic status are attributes which can be used to study cost utility analysis of cataract surgeries in governmental and non- governmental organizations. Maximum beneficiaries are those with maximum visual loss. Hence early surgical intervention is necessary. Bilateral visual loss impairs quality of life more than unilateral blindness. Hence prioritization of surgeries for visual loss in both eyes is essential. Manual Small Incision cataract surgery is an cost effective procedure in visual rehabilitation. National Program for Control of Blindness is effective in reducing blindness in rural India. From a societal perspective reducing blindness improves quality of life and reduces disability status among senior citizens.

Financial Interest:

NONE