Cost-Benefit Analysis for Universal Cataract Coverage in India for 2018

Abstract

AbstractImportanceCataract is the leading cause of curable blindness in India needing scale-up of coverage. However, the costs and benefits of such scale-up remain unknown.ObjectiveTo calculate the annual scale-up costs, economic benefits of disease burden averted, and the net benefits of covering cataract needs.DesignThis is a retrospective cross-sectional analysis for 2018-19.SettingWe look at population level data of India and its 30 states.Main Outcomes and MeasuresData on cataract prevalence and disability-adjusted life-years (DALYs) was taken from the Global Burden of Disease (GBD) 2019 while cataract operations were taken from the National Health Profile (NHP) 2020. We used ten per capita surgical costs from three sources. Gross domestic product and health expenditure were taken from the National Health Accounts (2021).For the cataract scale-up costs, we calculated the total need by multiplying cataract prevalence with per capita costs and the unmet need by multiplying the difference between the prevalence and surgeries achieved with the same costs. For economic benefits of averted cataract burden, we multiplied DALYs with non-health gross domestic product, i.e., GDP minus the government health expenditure. To calculate DALYs for unmet needs we multiplied DALYs for total need with the ratio of unmet to total needs. For net benefits, we subtracted the scale-up costs for meeting total and unmet needs from economic benefits. All monetary values were adjusted for inflation and converted to USD 2020.ResultsThe annual scale-up costs for covering total cataract needs in India were 0.92 - 4.9 billion USD. Costs for covering unmet needs were 0.72 - 3.82 billion USD. Nationally, the economic benefit of averting the total cataract disease burden was 12.4 (95%UI: 8.9 - 16.7) billion USD, while the for covering the unmet burden was 9.7 (95%UI: 6.93 - 13) billion USD. Annual net benefits of covering total needs were 7.53 - 11.5 billion USD. Net benefits of covering unmet needs were 5.9 - 9 billion USD. Net benefits varied widely across states.Conclusion and RelevanceScaling up cataract coverage is cost-beneficial. In over 90% of the scenarios considered, all Indian states have net economic benefits from the scale-up.Key PointsQuestionWhat are the costs and benefits of scaling up cataract coverage in India?FindingsIn this cost-benefit analysis, annual scale-up costs for meeting total cataract needs in India were 0.92 to 4.9 billion USD while the annual net benefits were 7.53 to 11.5 billion USD, several folds above the costs.MeaningUniversal cataract coverage is cost-beneficial to India. Further, scale-up costs form only a small percentage of the country’s gross domestic product.