Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
Cost Eff Resour Alloc. 2014 Feb 25;12(1):6. doi: 10.1186/1478-7547-12-6.
To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia.
Primary 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.
Utility 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.
In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions.
评估赞比亚白内障手术和屈光不正/老视矫正的成本效益。
从三家医疗机构招募的 170 名白内障患者和 113 名屈光不正/老视患者前瞻性队列研究中收集了有关成本和健康相关生活质量的原始数据。6 个月后，分别有 77 名和 41 名接受白内障手术和眼镜的患者可获得随访数据。通过对三家医疗机构的患者访谈和微观成本核算来确定成本。通过在白内障手术或配镜前和 6 个月后使用 EQ-5D 生活质量工具来收集效用值。使用概率状态转移模型生成具有不确定性范围的成本效益估计值。
在接受白内障手术和配镜后，患者样本的效用值显著提高。每获得一个质量调整生命年的增量成本分别为白内障手术 259 美元和屈光不正矫正 375 美元。白内障手术和屈光不正矫正的增量成本效益比低于赞比亚人均国民总收入的概率分别为 95%。
尽管已证实具有成本效益，但严重的卫生系统限制可能会阻碍干预措施的扩大。
