1
|
Ginel J, Burguera N, Piñero D, Sáez-Martín A, Haro De Rosario A, Fernández J. Economic evaluations in cataract surgery: a narrative review. Eye (Lond) 2024; 38:1418-1424. [PMID: 38347178 PMCID: PMC11126667 DOI: 10.1038/s41433-024-02965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/07/2023] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
Economic evaluations are tools for assessing emerging technologies and a complement for decision-making in healthcare systems. However, this topic may not be familiar for doctors and academics, who may be confused when interpreting the results of studies using these tools. Cataract is a disease which has received special attention in healthcare systems due to its high incidence, the great impact that it could have on patients' quality of life, and the fact that it can be definitively solved in almost all cases through cataract surgery. Historically, economic evaluations in cataract surgery have been conducted for many purposes by simply assessing whether the surgery is cost-effective for specific questions related to the implantation of multifocal intraocular lenses, surgical techniques, optimizing assessments, preventing diseases or complications, etc. Moreover, although there are systematic reviews about cataract surgery and narrative reviews introducing the concept of economic evaluations, as far as we know, no previous study has been conducted that synthesizes and integrates evidence coming from both fields. Thus, the purpose of this narrative review is to introduce doctors and academics to economic evaluation tools, to describe how these have been historically applied to cataract surgery, and to provide special considerations for the correct interpretation of economic studies.
Collapse
Affiliation(s)
- José Ginel
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain.
| | - N Burguera
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
| | - D Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Department of Ophthalmology (IMQO-Oftalmar), Vithas Medimar International Hospital, Alicante, Spain
| | - A Sáez-Martín
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - A Haro De Rosario
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - J Fernández
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
| |
Collapse
|
2
|
Willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. PLoS One 2021; 16:e0248618. [PMID: 33760830 PMCID: PMC7990211 DOI: 10.1371/journal.pone.0248618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction In Ethiopia, cataract surgery is mainly provided by donors free of charge through outreach programs. Assessing willingness to pay for patients for cataract surgery will help explain how the service is valued by the beneficiaries and design a domestic source of finance to sustain a program. Although knowledge concerning willingness to pay for cataract surgery is substantive for developing a cost-recovery model, the existed knowledge is limited and not well-addressed. Therefore, the study aimed to assess willingness to pay for cataract surgery and associated factors among cataract patients in Outreach Site, North West Ethiopia. Methods A cross-sectional outreach-based study was conducted on 827 cataract patients selected through a simple random sampling method in Tebebe Gion Specialized Hospital, North West Ethiopia, from 10/11/2018 to 14/11/2018. The data were collected using a contingent valuation elicitation approach to elicit the participants’ maximum willingness to pay through face to face questionnaire interviews. The descriptive data were organized and presented using summary statistics, frequency distribution tables, and figures accordingly. Factors assumed to be associate with a willingness to pay were identified using a Tobit regression model with a p-value of <0.05 and confidence interval (CI ≠ 0). Results The study involved 827 cataract patients, and their median age was 65years. About 55% of the participants were willing to pay for the surgery. The average amount of money willing to pay was 17.5USD (95% CI; 10.5, 35.00) and It was significantly associated with being still worker (β = 26.66, 95% CI: 13.03, 40.29), being educated (β = 29.16, 95% CI: 2.35, 55.97), free from ocular morbidity (β = 28.48, 95% CI: 1.08, 55.90), duration with the condition, (β = -1.69, 95% CI: -3.32, -0.07), admission laterality (β = 21.21, 95% CI: 3.65, 38.77) and remained visual ability (β = -0.29, 95% CI (-0.55, -0.04). Conclusions Participants’ willingness to pay for cataract surgery in outreach Sites is much lower than the surgery’s actual cost. Early intervention and developing a cost-recovery model with multi-tiered packages attributed to the neediest people as in retired, less educated, severely disabled is strategic to increase the demand for service uptake and service accessibility.
Collapse
|
3
|
Treatment outcomes of retinal vein occlusion in clinical practice in Nepal. BMC Ophthalmol 2021; 21:92. [PMID: 33602158 PMCID: PMC7890616 DOI: 10.1186/s12886-021-01857-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the treatment outcomes of retinal vein occlusion (RVO) in a routine clinical practice in Nepal. METHODS This was a retrospective analysis of observational data of patients with RVO who attended the retina clinic of the Tilganga Institute of Ophthalmology from 1 November 2017 to 31 October 2018. The main outcome was the mean change in visual acuity (VA) at 12 months from the start of treatment. Other outcomes of interest were the mean change in central subfield thickness (CST) and the number of treatments over 12 months. RESULTS A total of 99 eyes (of 99 patients) with RVO (60 - branch RVO [BRVO] and 39 - central RVO [CRVO] were available for the analysis. Eyes with CRVO had worse VA and CST at baseline. Eyes in both groups were similar for age, associated factors for RVO, duration of vision loss and the presence of ischemia at baseline. The mean (95% Confidence Interval [CI]) VA change at 12 months for BRVO was - 0.35 (- 0.46, - 0.23) logMAR (p < 0.001) from a mean (SD) of 0.75 (0.42) logMAR at baseline with 63% achieving VA < 0.3 logMAR while for CRVO it was - 0.35 (- 0.46, - 0.23) logMAR (p = 0.19) from 1.13 (0.61) logMAR at baseline and VA < 0.3 logMAR in 36%. The mean (95% CI) change in CST over 12 months was - 114 (- 189, - 40) μm (p = 0.003) from a mean (SD) of 423 (151) μm at baseline for BRVO and - 184(- 276, - 91) μm (p < 0.001) from 519 (213) μm for CRVO. Patients in both groups received a median of 2 bevacizumab injections over 12 months. Around 37% eyes were lost before 12 months' observation. The mean VA and CST trajectory in these eyes at their last visit was similar to those that completed 12 months. CONCLUSION The outcomes of RVO over the 12 months were inferior and the number of treatments fewer than those of the clinical trials and other reports from routine clinical practice. Future studies to identify the treatment barriers are warranted to improve the treatment outcomes in our patients.
Collapse
|
4
|
Zhang XJ, Li EY, Leung CKS, Musch DC, Zheng CR, He MG, Chang DF, Lam DSC. Willingness to pay for cataract surgery in baiyin district, northwestern China. Ophthalmic Epidemiol 2020; 28:205-212. [PMID: 32822250 DOI: 10.1080/09286586.2020.1812089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate willingness to pay for cataract surgery, and its associations, in Northwestern China. METHODS Four hundred thirty-eight persons aged 50 years and above, diagnosed with cataract indicated for surgery, identified in an outreach screening program were included. Subjects were offered a willingness-to-pay interview for the maximal amount that the subjects would be willing to pay for a cataract surgery. Age, gender, literacy, education level, occupation, and annual household income were recorded. RESULTS Among 328 (74.9%) subjects who completed the interview, 197 (60.1%) participants were willing to pay something for the cataract surgery (mean, 902.9 ± 856.7 renminbi[RMB], [US$ 145 ± 137]; median, 500RMB, US$ 78). Individuals with presenting visual acuity (PVA) in the worse eye ≤6/60 (OR: 2.1, 95% CI: 1.3-3.2) and a high annual household incomes (OR: 2.0, 95% CI: 0.9-4.6) were likely to be willing to pay for the surgery, as revealed in the regression models. Willingness to pay any amount for cataract surgery was more likely among literate persons (OR: 1.5, 95% CI: 1.0-2.4) and persons with non-agricultural occupation (OR: 1.8, 95% CI: 1.0-3.2). CONCLUSIONS The amount that subjects were willing to pay is significantly less than the current cost of cataract surgery (5000 RMB, US$320) in the area. Providing low-cost cataract surgery to patients in a financially sustainable manner is important to increase uptake of cataract surgery among rural residents in Northwest China.
Collapse
Affiliation(s)
- Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Emmy Y Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Project Vision Charitable Foundation, Hong Kong, China
| | | | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Ming Guang He
- State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
| | - David F Chang
- The University of California, San Francisco, Los Altos, California, USA
| | - Dennis Shun-Chiu Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China.,Project Vision Charitable Foundation, Hong Kong, China.,C-MER Dennis Lam & Partners Eye Center, C-MER International Eye Care Group, Hong Kong.,International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| |
Collapse
|
5
|
Chariwala RA, Shah SP, Patel D, Chaudhari SP, Gajiwala UR. Rapid Assessment of Avoidable Blindness and Willingness to Pay for Cataract Surgery in Tribal Region of Surat District of Gujarat State, India. Ophthalmic Epidemiol 2020; 28:152-159. [PMID: 32673143 DOI: 10.1080/09286586.2020.1792939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To estimate prevalence and causes of avoidable blindness among people ≥50 years and to assess willingness to pay (WTP) for cataract surgery in tribal region of south Gujarat, India. METHODS A cross-sectional population based survey was conducted with 44 randomly selected clusters each having 50 people aged ≥50 years selected by probability proportional to size of sampling. Adults identified with cataract causing visual loss (<6/18) in any eye were interviewed to assess their WTP for surgery. RESULTS Total of 2137 examined out of 2200 people enumerated (response rate 97.1%). The prevalence of blindness (Presenting Visual Acuity (PVA)<3/60 in better eye) was 2.23% (95% CI: 2.95%-1.51%). Cataract was main cause of blindness (67.3%) followed by corneal scarring (8.2%). Major barrier to cataract surgery cited by bilaterally blind people was lack of escort to the surgical facility (34.3%). Cataract surgical coverage (CSC) was 84.9% (eyes) and 92% (persons). Of the 492 people interviewed to assess WTP for their surgery, only 36.4% people were willing to pay. CONCLUSION The tribal population has a high poverty profile in India. Within this group, cataract remains the main treatable cause of blindness despite a high CSC. Assessment of barriers suggested that a well-coordinated outreach programme with free transport facilities to the surgical facility is required along with strategies to improve accessibility and prioritising cataract blind in the community. One-third of people were willing to pay for their surgeries implying that cross subsidization or tier system could be feasible for eye care programme sustainability.
Collapse
Affiliation(s)
- Rohan A Chariwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Shaheen P Shah
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Daksha Patel
- International Center for Eye Health (ICEH), London School of Hygiene and Tropical Medicine (LSHTM), London, UK
| | - Sheetal P Chaudhari
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| | - Uday R Gajiwala
- Department of Public Health and Research in Eye Care, Tejas Eye Hospital, Divyajyoti Trust, Mandvi, Gujarat, India
| |
Collapse
|
6
|
Islam MN, Engels T, Hossain S, Sarker M, Rabbani A. Willingness to Pay for Cataract Surgeries Among Patients Visiting Eye Care Facilities in Dhaka, Bangladesh. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:545-554. [PMID: 31065885 DOI: 10.1007/s40258-019-00478-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cataract is the leading cause of avoidable blindness globally. It is estimated that 89% of people with visual impairment live in low- and middle-income countries where the cost of cataract surgery represents a major barrier for accessing these services. Developing self-sustaining healthcare programs to cater the unmet demands warrants a better understanding of patients' willingness to pay (WTP) for their services. OBJECTIVES Using a sample of patients visiting eye care facilities in Dhaka, Bangladesh, we estimate WTP for two different cataract extraction techniques, namely small incision cataract surgery (SICS) and phacoemulsification. METHODS We used contingent valuation (CV) approach and elicited WTP through double-bounded dichotomous choice experiments. We interviewed 556 randomly selected patients (283 for SICS and 273 for phacoemulsification) from five different eye care hospitals of Dhaka. In this paper, we estimated the mean and marginal WTP using interval regression models. We also compared the estimated WTP and stated demand for cataract surgeries against the prevailing market prices of SICS and phacoemulsification. RESULTS We found the mean WTP of BDT 7579 (US$93) for SICS and BDT 10,208 (US$126) for phacoemulsification are equivalent to 12 and 16 days of household income, respectively. Household income and assets appeared as the major determinants of WTP for cataract surgeries. However, we did not find any significant association with gender, occupation, and household size among other socioeconomic characteristics. Comparisons between market prices and average WTP suggest it is possible to have a viable market for SICS, but a subsidy-based model for phacoemulsification will be financially challenging because of low WTP and high costs. CONCLUSION Our findings suggest lower-cost SICS can potentially provide patients access to surgeries to treat cataract conditions. Moreover, price discrimination and cross-subsidization could be a viable strategy to increase the service-uptake as well as ensure financial sustainability.
Collapse
Affiliation(s)
- Muhammed Nazmul Islam
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Thomas Engels
- Sightsavers, 35 Perrymount Road, Haywards Health, West Sussex, RH16 3BW, England, UK
| | - Shafayet Hossain
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
| | - Malabika Sarker
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
- Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Atonu Rabbani
- BRAC James P Grant School of Public Health, BRAC University, 68 Shahid Tajuddin Ahmed Avenue, Mohakhali, Dhaka, 1212, Bangladesh
- Department of Economics, University of Dhaka, Dhaka, 1000, Bangladesh
| |
Collapse
|
7
|
Norris AJ, Norris CE. Factors influencing non-attendance to scheduled eye surgery in rural Swaziland. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
8
|
A Study on the Awareness of Cataract Disease and Treatment Options in Patients who Need Surgery in a Rural Area of Eastern China. Eur J Ophthalmol 2018; 18:544-50. [DOI: 10.1177/112067210801800407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
9
|
Ibrahim N, Ramke J, Pozo-Martin F, Gilbert CE. Willingness to pay for cataract surgery is much lower than actual costs in Zamfara state, northern Nigeria. Ophthalmic Epidemiol 2017; 25:227-233. [PMID: 29182463 DOI: 10.1080/09286586.2017.1408845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Direct medical and non-medical costs incurred by those undergoing subsidised cataract surgery at Gusau eye clinic, Zamfara state, were recently determined. The aim of this study was to assess the willingness to pay for cataract surgery among adults with severe visual impairment or blindness from cataract in rural Zamfara and to compare this to actual costs. METHODS In three rural villages served by Gusau eye clinic, key informants helped identify 80 adults with bilateral severe visual impairment or blindness (<6/60), with cataract being the cause in at least one eye. The median amount participants were willing to pay for cataract surgery was determined. The proportion willing to pay actual costs of the (i) subsidised surgical fee (US$18.5), (ii) average non-medical expenses (US$25.2), and (iii) average total expenses (US$51.2) at Gusau eye clinic were calculated. Where participants would seek funds for surgery was determined. RESULTS Among 80 participants (38% women), most (n = 73, 91%) were willing to pay something, ranging from <US$1 to US$186 (median US$18.5, interquartile range 6.2-31.1). Approximately half of the participants (n = 41) were willing to pay US$18.5 (78% men), one-third (n = 26) were willing to pay US$25.2 (77% men); and 11% (n = 9) were willing to pay US$51.2 (all men). Only six participants (8%) already had the money to pay; one quarter (n = 20) would need to sell possessions to raise the funds. CONCLUSION Willingness to pay for cataract surgery among adults with operable cataract in rural Zamfara state is far lower than current costs of undergoing surgery. People who were widowed-most of whom were women-were willing to pay least. Further financial support is required for cataract surgery to be universally accessible.
Collapse
Affiliation(s)
- Nazaradden Ibrahim
- a Zamfara State Eye Care Programme, Ministry of Health , Gusau , Nigeria
| | - Jacqueline Ramke
- b Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences , University of Auckland , Auckland , New Zealand
| | - Francisco Pozo-Martin
- c Department of Global Health and Development , London School of Hygiene and Tropical Medicine , London , UK
| | - Clare E Gilbert
- d International Centre for Eye Health, Clinical Research Unit, Department of Infectious & Tropical Diseases , London School of Hygiene and Tropical Medicine , London , UK
| |
Collapse
|
10
|
Multiple deprivation, vision loss, and ophthalmic disease in adults: global perspectives. Surv Ophthalmol 2017; 63:406-436. [PMID: 29100897 DOI: 10.1016/j.survophthal.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/19/2022]
Abstract
The association between socioeconomic position and morbidity and mortality has long been recognized. We evaluate the evidence for an association between multiple aspects of deprivation and ocular health in a global context. This is a systematic review of studies that evaluated deprivation in the adult population in the context of the major acquired causes of visual loss such as cataract, diabetic eye disease, glaucoma, age-related macular degeneration, and ocular trauma. The search strategy identified relevant studies reported between 1946 and August 2016, with randomized control trials, case-control, cohort, and cross-sectional study designs being selected for inclusion. The studies identified in this review from across the world demonstrate the extent to which the common themes such as low educational attainment and low income may be associated with increased incidence of various sight-threatening conditions and may adversely affect access to specialist assessment and delivery of treatment. Health inequality may always persist, but an increased recognition of the importance of the various impacts of deprivation may empower policy makers to target limited resources to the most vulnerable groups in order to deliver the greatest benefit.
Collapse
|
11
|
Radhakrishnan M, Venkatesh R, Valaguru V, Frick KD. Economic and social factors that influence households not willing to undergo cataract surgery. Indian J Ophthalmol 2016; 63:594-9. [PMID: 26458477 PMCID: PMC4652250 DOI: 10.4103/0301-4738.167116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Literature investigating barriers to cataract surgery is mostly done from the patient's point of view. However, many medical decisions are jointly taken by household members, especially in developing countries such as India. We investigated from the household head's (or representative's) perspective, households’ view on those not willing to undergo cataract surgery along with the economic and social factors associated with it. Materials and Methods: A cross-sectional survey of four randomly selected village clusters in rural areas of Theni district, Tamil Nadu, India, was conducted to elicit the willingness to pay for cataract surgery by presenting “scenarios” that included having or not having free surgery available. The presentation of scenarios allowed the identification of respondents who were unwilling to undergo surgery. Logistic regression was used to estimate relationships between economic and social factors and unwillingness to undergo cataract surgery. Results: Of the 1271 respondents, 49 (3.85%) were not willing to undergo surgery if they or their family members have cataract even if free surgery were available. In the regression results, those with good understanding of cataract and its treatment were less likely to be unwilling to undergo cataract surgery. Those not reporting household income were more likely to be unwilling to undergo cataract surgery. Conclusions: As a good understanding of cataract was an important predictor of willingness to undergo cataract surgery, health education on cataract and its intervention can improve uptake.
Collapse
Affiliation(s)
| | - Rengaraj Venkatesh
- Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Puducherry, India
| | | | | |
Collapse
|
12
|
Wandei S, Nangami M, Egesa O. Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya. AIDS Care 2015; 28:471-4. [PMID: 26654584 DOI: 10.1080/09540121.2015.1114998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.
Collapse
Affiliation(s)
- Stephen Wandei
- a Department of Health Management and Policy, School of Public Health , Moi University , Eldoret , Kenya
| | - Mabel Nangami
- a Department of Health Management and Policy, School of Public Health , Moi University , Eldoret , Kenya
| | - Omar Egesa
- b Department of Anthropology and Human Ecology, School of Arts and Social Sciences , Moi University , Eldoret , Kenya
| |
Collapse
|
13
|
Wang M, Zuo Y, Lin X, Ling Y, Lin X, Li M, Lamoureux E, Zheng Y. Willingness to Pay for Cataract Surgery Provided by a Senior Surgeon in Urban Southern China. PLoS One 2015; 10:e0142858. [PMID: 26575284 PMCID: PMC4648520 DOI: 10.1371/journal.pone.0142858] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/27/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose To study willingness to pay for cataract surgery and surgical service provided by a senior cataract surgeon in urban Southern China. Methods This study was a cross-sectional willingness-to-pay (WTP) interview using bidding formats. Two-hundred eleven persons with presenting visual impairment in either eye due to cataract were enrolled at a tertiary eye hospital. Participants underwent a comprehensive eye examination and a WTP interview for both surgery and service provided by a senior surgeon. Demographic information, socioeconomic status and clinical data were recorded. Results Among 211 (98% response rate) persons completing the interview, 53.6% were women and 80.6% were retired. About 72.2% had a monthly income lower than 1000 renminbi (US $161). A total of 189 (89.6%) were willing to pay for cataract and the median amount of WTP was 6000 renminbi (US$968). And 102 (50.7%) were willing to pay additional fees for surgery performed by a senior surgeon, and the median amount of WTP was 500 renminbi (US$81). In regression models adjusting for age and gender, persons with preexisting eye diseases other than cataract, were more likely to pay for cataract surgery and service provided by a senior surgeon (P = 0.04 for both). Conclusions In urban China, cataract patients, especially those with preexisting eye conditions, are willing to pay additional fees for a senior surgeon. Moving to a system where the price of cataract surgery is proportional to the consultant’ skill and expertise is possible and may have a potential impact on waiting list and quality of eye care. Further studies are needed to examine the impact of such pricing system on attitudes and choices of cataract patients.
Collapse
Affiliation(s)
- Mei Wang
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yajing Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xianhua Lin
- Guangzhou Institutes of Biomedicine and Health, Chinese Academy of Sciences, Guangzhou, China
| | - Yunlan Ling
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Lin
- Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, China
| | - Mingge Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Centre for Eye Research Australia, University of Melbourne, Melbourne, Australia
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- * E-mail:
| |
Collapse
|
14
|
Mitsuhiro MH, Berezovsky A, Belfort R, Ellwein LB, Salomao SR. Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study. Ophthalmic Epidemiol 2014; 22:253-9. [PMID: 25310584 DOI: 10.3109/09286586.2014.966849] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine uptake, barriers and outcomes in the follow-up of patients referred for free-of-charge, expedited cataract surgery in the Sao Paulo Eye Study (SPES). METHODS SPES was a population-based study of urban, low-middle income residents aged ≥50 years. Presenting visual acuity (PVA), best-corrected visual acuity, refraction, and slit-lamp examination were performed in 3677 participants. For subjects with cataract as a principal cause of best-corrected visual acuity ≤20/40, surgery was offered free of charge. Two years after the baseline study, surgery uptake, barriers to surgery, and visual outcomes were analyzed. RESULTS Among 210 (5.71%) participants who had a cataract surgery indication at baseline, 164 (78.1%) were successfully contacted and 55 (33.5%) reported being operated on for cataract, with 51 agreeing to be re-examined. In a multiple logistic regression model, age, sex, schooling, previous cataract surgery, and PVA at baseline were not significantly associated with surgery uptake. Co-existing health conditions (20.4%), fear of surgery (12.2%) and fear of losing eyesight (11.6%) were the most frequent barriers to cataract surgery adherence. Among the 69 eyes operated on in the interval between baseline and follow-up, PVA ≥20/63 was observed in 50 (72.6%, 95% confidence interval, CI, 62.2-82.3%), PVA <20/63-20/200 in 11 (15.8%, 95% CI 8.9-22.9%) and PVA <20/200 in 8 (11.6%, 95% CI 5.3-17.9%). CONCLUSIONS Quality of surgery is an increasing determinant of uptake rates. Although free-of-charge and expedited cataract surgery was offered, surgical outcomes might have influenced the low uptake. Aside from cataract surgery campaigns, improvement of surgeon skills, accurate biometry, treatment of ocular comorbidities, postoperative follow-up and eye-care education are needed.
Collapse
Affiliation(s)
- Marcia H Mitsuhiro
- Departamento de Oftalmologia, Escola Paulista de Medicina, Universidade Federal de Sao Paulo , Sao Paulo, SP , Brasil and
| | | | | | | | | |
Collapse
|
15
|
Radhakrishnan M, Venkatesh R, Valaguru V, Frick KD. Household preferences for cataract surgery in rural India: a population-based stated preference survey. Ophthalmic Epidemiol 2013; 22:34-42. [PMID: 24067063 DOI: 10.3109/09286586.2013.783083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Cataract surgery is provided both by the private and public sector in India. Free cataract surgery (with minimal amenities) funded through subsidies/reimbursements by government and non-governmental organizations is provided for underprivileged and poor patients, especially in rural areas. However, no evidence exists whether this free surgery is used by those who could afford to pay and are willing to pay for cataract surgery. So, understanding willingness to pay and preferences for cataract surgery in the population can have important policy implications. METHODS A cross-sectional survey of 1272 households from four randomly drawn rural household clusters in Theni district, Tamilnadu state, India was conducted. Respondents from households were presented with scenarios (with and without free surgery availability) to elicit their willingness to pay and preferences for cataract surgery. RESULTS Of those willing to undergo surgery; 696 (57%) were willing to undergo paid surgery, 148 (12%) only free surgery, and 378 (31%) paid surgery if no free surgery was available. In a multinomial logit model, household wealth measures, income variables and family history of cataract surgery largely distinguished the preferences. Good understanding of cataract and its intervention only marginally influenced preference for paid surgery. CONCLUSION A larger number of people were willing to pay when free surgery was not available. Free surgery may be crowding out surgery for which costs can be recovered. With non-cataract causes of blindness in the Indian population also requiring attention, this has implications for allocation of scarce resources.
Collapse
|
16
|
Dean WH, Sherwin JC, Kumwenda S, Angeletti M, Wiehler U. Willingness to Pay for Cataract Surgery in Post-operative Cataract Patients in Rural Malawi. Ophthalmic Epidemiol 2012; 19:265-71. [DOI: 10.3109/09286586.2012.708085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
17
|
Ko F, Frick KD, Tzu J, He M, Congdon N. Willingness to pay for potential enhancements to a low-cost cataract surgical package in rural southern China. Acta Ophthalmol 2012; 90:e54-60. [PMID: 21801337 DOI: 10.1111/j.1755-3768.2011.02207.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess determinants of patients' willingness to pay (WTP) for potential components of a multi-tiered cataract surgical package offered by a non-governmental organization (NGO) in rural China. DESIGN Cross-sectional study. METHODS Demographic and clinical data were collected from 505 patients presenting for cataract screening or surgery in Yangjiang, China. Willingness to pay for potential enhancements to the current surgery package was assessed using a bidding format with random payment cards. RESULTS Among 426 subjects (84.4%) completing interviews, the mean age was 73.9 ± 7.3 years, 67.6% were women and 73% (n = 310) would pay for at least one offering, with 33-38% WTP for each item. Among those who would pay, the mean WTP for food was US$1.68 ± 0.13, transportation US$3.24 ± 0.25, senior surgeon US$50.0 ± 3.36 and US$89.4 ± 4.19 for an imported intra-ocular lens (IOL). The estimated total recovery from these enhancements under various assumptions would be US$20-50 (compared to the current programme price of US$65). In multivariate models, WTP for the senior surgeon increased with knowledge of a person previously operated for cataract (OR = 2.13, 95% CI 1.42-3.18, p < 0.001). Willingness to pay for the imported IOL increased with knowledge of a previously operated person (OR = 1.85, 95% CI 1.24-2.75, p < 0.01) and decreased with age >75 years (OR = 0.61, 0.40-0.93, p < 0.05). CONCLUSIONS Opportunities exist to increase cataract programme revenues through multi-tiered offerings in this setting, allowing greater subsidization of low-income patients. Personal familiarity with cataract surgery is important in determining WTP.
Collapse
Affiliation(s)
- Fang Ko
- Wilmer Eye Institute, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
18
|
Grimes CE, Bowman KG, Dodgion CM, Lavy CBD. Systematic Review of Barriers to Surgical Care in Low-Income and Middle-Income Countries. World J Surg 2011; 35:941-50. [DOI: 10.1007/s00268-011-1010-1] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Kandel RP, Rajashekaran SR, Gautam M, Bassett KL. Evaluation of alternate outreach models for cataract services in rural Nepal. BMC Ophthalmol 2010; 10:9. [PMID: 20334695 PMCID: PMC2860345 DOI: 10.1186/1471-2415-10-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 03/25/2010] [Indexed: 12/02/2022] Open
Abstract
Background Bharatpur Eye Hospital in Chitwan District, a primarily agrarian setting in south-central Nepal, reduced the number of diagnostic screening and treatment (DST) camps by one half (151 to 75) in an attempt to increase both the efficiency of its outreach program and the number of people that go directly to the hospital for service. The Hospital evaluated the two program models in terms of program costs, cataract surgical utilization, hospital direct payment and patient equity. Methods The study is a prospective, before and after, study of the impact of an alternate outreach model on cataract service utilization patterns and cost per outreach camp and cost per cataract surgery at Bharatpur Eye Hospital, comparing the service years July 2006 to June 2007, with July 2007 to June 2008. Study findings were based on routinely gathered hospital and outreach administrative data. Results The total cost of the DST camps decreased by approximately US$2000. The cost per camp increased from US$52 to $78 and the cost per cataract surgery decreased from US$ 3.80 to $3.20. The number of patients who went directly to the hospital, and paid for cataract surgery, increased from 432 (17%) to 623 (25%). The total number of cataract surgical procedures at Bharatpur Eye Hospital remained very similar between the two service years (2501 and 2449, respectively). The presenting visual acuity and sex of the two cataract surgical populations were very similar (favouring women, 53 and 55% in the two years, respectively). A shift toward younger men and women occurred with a 245 (64%) increase in people age 50-59 years, and shift away from people age 70 years and older with a 236 (22%) reduction. The age and sex distribution of the direct paying patients were very similar in the two years. Conclusion The new, more concentrated, more rural DST model of service delivery reduced overall outreach program costs, cost per cataract surgery transported, while increasing direct payments to the hospital, with a significant decrease in the number of people age 70 and older in the first year.
Collapse
Affiliation(s)
- Ram P Kandel
- Seva Foundation/Seva Canada Society, Nepal Eye Hospital Complex, Tripureswor, Kathmandu Nepal.
| | | | | | | |
Collapse
|
20
|
Baruwa E, Tzu J, Congdon N, He M, Frick KD. Reversal in Gender Valuations of Cataract Surgery After the Implementation of Free Screening and Low-Priced High-Quality Surgery in a Rural Population of Southern China. Ophthalmic Epidemiol 2009; 15:99-104. [DOI: 10.1080/09286580801999118] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Shah SP, Jadoon MZ, Dineen B, Bourne RRA, Johnson GJ, Gilbert CE, Khan MD. Refractive Errors in the Adult Pakistani Population: The National Blindness and Visual Impairment Survey. Ophthalmic Epidemiol 2009; 15:183-90. [DOI: 10.1080/09286580802105822] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Maxwell WA, Waycaster CR, D'Souza AO, Meissner BL, Hileman K. A United States cost-benefit comparison of an apodized, diffractive, presbyopia-correcting, multifocal intraocular lens and a conventional monofocal lens. J Cataract Refract Surg 2008; 34:1855-61. [PMID: 19006730 DOI: 10.1016/j.jcrs.2008.07.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To demonstrate the value, from the patient's perspective, of an apodized, diffractive, presbyopia-correcting multifocal intraocular lens (MF-IOL) compared to a conventional monofocal intraocular lens (CM-IOL). SETTING Open-label, multi-site U.S. clinical trial. METHODS A cost-benefit analysis was conducted using cataract patients' willingness-to-pay (WTP) for spectacle independence as the measure of economic benefit. WTP was elicited from participants in a clinical trial comparing a MF-IOL and a CM-IOL. Costs borne by patients were obtained from standard reference sources. A 14-year analytical timeframe was used, and a 3% annual discount rate was applied to both costs and benefits. The outcome of interest was net benefit (difference between benefits and costs). A probabilistic sensitivity analysis was used to confirm the robustness of the economic results. RESULTS Four hundred ninety-five patients provided WTP estimates for spectacle independence (MF-IOL, n = 339; CM-IOL, n = 156). Eighty percent of all patients were willing to pay at least $5 per day to be spectacle independent. The incremental acquisition cost associated with bilateral implantation of 2 MF-IOLs was estimated at $4,000. Eighty percent in the MF-IOL group and 8% in the CM-IOL group reported post-operative spectacle independence. The net benefit was $11,670 in the MF-IOL group and $155 in the CM-IOL group. The probabilistic sensitivity analysis confirmed the robustness of the economic outcomes. CONCLUSION The net benefit of the MF-IOL exceeded its acquisition cost and the net benefit of the CM-IOL, demonstrating its value to select cataract patients willing to pay a premium for spectacle independence.
Collapse
|
23
|
Athanasiov PA, Casson RJ, Newland HS, Shein WK, Muecke JS, Selva D, Aung T. Cataract surgical coverage and self-reported barriers to cataract surgery in a rural Myanmar population. Clin Exp Ophthalmol 2008; 36:521-5. [DOI: 10.1111/j.1442-9071.2008.01829.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
24
|
Shih HC, Chou P, Chen SJ, Liu JH, Lee FL, Liu CM, Tung TH. A community-based study of the willingness to pay associated with screening for diabetic retinopathy among type 2 diabetes in Kinmen, Taiwan. J Epidemiol 2008; 17:186-93. [PMID: 18094517 PMCID: PMC7058465 DOI: 10.2188/jea.17.186] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In Taiwan, there were few population-based studies of WTP values related to DR screening among persons with type 2 diabetes. This community-based study was to explore the willingness-to-pay (WTP) values for screening for diabetic retinopathy (DR) associated with varying degrees of DR among persons with type 2 diabetes in Kinmen, Taiwan. METHODS A total of 725 eligible community-dwelling adults diagnosed with type 2 diabetes received DR screening during 1999-2002 and then evaluated WTP values in 2003. Diagnosis of DR was performed by a panel of ophthalmologists using ophthalmoscopy and a 45-degree color retinal photographs to examine fundus after dilating pupils. WTP values were measured by discrete-choice method. RESULTS The 406 adults with type 2 diabetes participating in the WTP survey had a 56% response rate. Of 406 subjects, 265 (65.3%) said they would be willing to pay for DR screening to reduce blindness. The overall mean WTP value was New Taiwan Dollars 468.9±327.7 (US dollars 14.3±10.0). Age was borderline significant (p=0.07) related to WTP values. Those with severe stage DR had higher WTP values for screening than subjects with mild stage. CONCLUSIONS Degree of DR was the independent factor affecting WTP values in DR screening among community-dwelling adults with type 2 diabetes.
Collapse
Affiliation(s)
- Hui-Chuan Shih
- Department of Nursing, Kaohsiung Armed Forced General Hospital, Taipei, Taiwan
| | | | | | | | | | | | | |
Collapse
|
25
|
Chang MA, Congdon NG, Baker SK, Bloem MW, Savage H, Sommer A. The surgical management of cataract: barriers, best practices and outcomes. Int Ophthalmol 2007; 28:247-60. [PMID: 17712529 DOI: 10.1007/s10792-007-9121-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 06/11/2007] [Indexed: 10/22/2022]
Abstract
Cataract is the leading cause of blindness in the world. Cataract surgery has been shown by multiple studies to be one of the most cost-effective health interventions, and leads to a dramatic increase in quality of life and productivity for many patients. Though there has been marked improvement in the last several decades, surgical delivery services in developing nations are still suboptimal, and a large backlog in cataract cases continues to grow. To decrease this backlog, barriers to surgery, such as direct and indirect patient costs, geographic access to surgical facilities and surgeons, cultural factors, and patient education, must be addressed. In particular, access to services by women and rural patients needs to be improved. It is clear that extracapsular techniques are cost-effective and lead to better post-operative outcomes than intracapsular cataract extraction with aphakic correction. In addition, monitoring surgical outcomes is essential for improving the quality of surgical services. However, other issues regarding the delivery of cataract surgical services, including the role of average power intraocular lenses and the role of non-physician surgeons, are yet unresolved. Information about the true cost of surgery, including costs of surgeon training, equipment, and patient outreach programs, is needed so that the goal of self-sustaining programs may be obtained.
Collapse
Affiliation(s)
- Margaret A Chang
- The Johns Hopkins University Schools of Medicine and Public Health, 600 N. Wolfe Street, Wilmer 120, Baltimore, MD 21287, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Ramke J, du Toit R, Palagyi A, Brian G, Naduvilath T. Correction of refractive error and presbyopia in Timor-Leste. Br J Ophthalmol 2007; 91:860-6. [PMID: 17576709 PMCID: PMC1955644 DOI: 10.1136/bjo.2006.110502] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged >or=40 years in Timor-Leste. METHOD A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse than 6/18, but at least 6/18 with pinhole), uncorrected or undercorrected presbyopia (near vision worse than N8), and/or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. RESULTS Of 1470 people enumerated, 1414 were examined (96.2%). The "met refractive error need" in the sample was 2.2%, and the "unmet refractive error need" was 11.7%. The "refractive error correction coverage" was 15.7%. The "met presbyopic need" was 11.5%, and the "unmet presbyopic need" was 32.3%. The "presbyopia correction coverage" was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US$3 ( pound 1.52, euro 2.24) for spectacles, whereas 50.2% were unwilling to pay US$1 ( pound 0.51, euro 0.75). Women and rural dwellers were less likely to be willing to pay at least US$1 for spectacles. CONCLUSION Refractive error and presbyopia correction coverage rates are low in Timor-Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross-subsidisation spectacle system should be possible.
Collapse
Affiliation(s)
- J Ramke
- The International Centre for Eyecare Education, Sydney, New South Wales, Australia
| | | | | | | | | |
Collapse
|
27
|
Jadoon Z, Shah SP, Bourne R, Dineen B, Khan MA, Gilbert CE, Foster A, Khan MD. Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey. Br J Ophthalmol 2007; 91:1269-73. [PMID: 17556430 PMCID: PMC2001008 DOI: 10.1136/bjo.2006.106914] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified.
Collapse
Affiliation(s)
- Z Jadoon
- Pakistan Institute of Community Ophthalmlogy, Kyber Institute of Ophthalmic Medical Sciences, Peshawar, Pakistan
| | | | | | | | | | | | | | | |
Collapse
|
28
|
He M, Chan V, Baruwa E, Gilbert D, Frick KD, Congdon N. Willingness to Pay for Cataract Surgery in Rural Southern China. Ophthalmology 2007; 114:411-6. [PMID: 17197026 DOI: 10.1016/j.ophtha.2006.09.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Revised: 05/24/2006] [Accepted: 09/25/2006] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To study willingness to pay for cataract surgery, and its associations, in Southern China. DESIGN Cross-sectional willingness-to-pay interview incorporating elements of the open-ended and bidding formats. PARTICIPANTS Three-hundred thirty-nine persons presenting for cataract screening in Yangjiang, China, with presenting visual acuity (VA) < or = 6/60 in either eye due to cataract. METHODS Subjects underwent measurement of their VA and a willingness-to-pay interview. Age, gender, literacy, education, and annual income also were recorded. MAIN OUTCOME MEASURES Maximum amount that the subjects would be willing to pay for cataract surgery. RESULTS Among 325 (95.9%) subjects completing the interview, 169 (52.0%) were 70 years or older, 213 (65.5%) were women, and 217 (66.8%) had an annual income of <5000 renminbi (5000 = US 625 dollars). Eighty percent (n = 257) of participants were willing to pay something for surgery (mean, 442+/-444 renminbi [US 55 dollars+/-55]). In regression models, older subjects were willing to pay less (8 renminbi [US 1 dollar] per year of age; P = 0.01). Blind subjects were significantly more likely (odds ratio, 5.7; 95% confidence interval, 1.7-19.3) to pay anything for surgery, but would pay on average 255 renminbi (US 32 dollars) less (P = 0.004). Persons at the highest annual income level (>10,000 renminbi [US 1250 dollars]) would pay 50 dollars more for surgery than those at the lowest level (<5000 renminbi) (P = 0.0003). The current cost of surgery in this program is 500 renminbi (US 63 dollars). CONCLUSIONS Sustainable programs will need to attract younger, more well-to-do persons with better vision, while still providing access to the neediest patients.
Collapse
|
29
|
Mukhida K, Sharma MR, Shilpakar SK. Pediatric neurotrauma in Kathmandu, Nepal: implications for injury management and control. Childs Nerv Syst 2006; 22:352-62. [PMID: 16170573 DOI: 10.1007/s00381-005-1235-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECTS There is a scarcity of data regarding childhood neurological injuries in developing countries such as Nepal. The epidemiology of acute pediatric neurotrauma in Kathmandu was studied to assess the implications of these data for injury prevention programs. METHODS The clinical records of patients <or=18 years who presented to Tribhuvan University Teaching Hospital between April 1, 2001 and April 1, 2004 with acute neurological trauma and were subsequently admitted to hospital were retrospectively reviewed. A standard proforma was used to collect information on patient demographics, the nature and etiology of the injuries, their acute management, and outcomes. CONCLUSIONS Four hundred sixteen injured children were admitted to hospital, and the charts for 352 (85%) were available for review. Spinal injuries were relatively rare (4%) compared to head injuries (96%). Falls were the most common cause of injuries (61%). It took significantly longer (p<0.001) for children injured in rural Nepal (62%) to obtain neurosurgical care (30.1 h) than those injured within Kathmandu (7.1 h). A Glasgow Outcome Score of 5 was obtained for 96%, 76%, and 22% of patients with mild, moderate, or severe head injuries, respectively. Besides efforts to improve prehospital transport and acute management of these injuries, preventive measures that are applicable to the Nepalese scenario are urgently needed. Interventions should focus on health education programs directed at parents and children and upgrading of road safety measures. Neurological injuries must also be viewed in the context of the broader social issues in Nepal that contribute to injury.
Collapse
Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto, Toronto, Canada.
| | | | | |
Collapse
|
30
|
Hubley J, Gilbert C. Eye health promotion and the prevention of blindness in developing countries: critical issues. Br J Ophthalmol 2006; 90:279-84. [PMID: 16488944 PMCID: PMC1856969 DOI: 10.1136/bjo.2005.078451] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This review explores the role of health promotion in the prevention of avoidable blindness in developing countries. Using examples from eye health and other health topics from developing countries, the review demonstrates that effective eye health promotion involves a combination of three components: health education directed at behaviour change to increase adoption of prevention behaviours and uptake of services; improvements in health services such as the strengthening of patient education and increased accessibility and acceptability; and advocacy for improved political support for blindness prevention policies. Current eye health promotion activities can benefit by drawing on experiences gained by health promotion activities in other health topics especially on the use of social research and behavioural models to understand factors determining health decision making and the appropriate choice of methods and settings. The challenge ahead is to put into practice what we know does work. An expansion of advocacy-the third and most undeveloped component of health promotion-is essential to convince governments to channel increased resources to eye health promotion and the goals of Vision 2020.
Collapse
Affiliation(s)
- J Hubley
- School of Health and Community Care, Leeds Metropolitan University, 21 Arncliffe Road, Leeds LS16 5AP, UK.
| | | |
Collapse
|
31
|
Lewallen S, Geneau R, Mahande M, Msangi J, Nyaupumbwe S, Kitumba R. Willingness to pay for cataract surgery in two regions of Tanzania. Br J Ophthalmol 2006; 90:11-3. [PMID: 16361657 PMCID: PMC1856885 DOI: 10.1136/bjo.2005.079715] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Knowing what rural populations are willing to pay for cataract surgery is essential if improvements in cost recovery in eye care service provision programmes are to take place. The authors sought to learn about willingness to pay for cataract surgery in two separate regions of Tanzania. METHODS Patients desiring cataract surgery were interviewed in Kilimanjaro Region and Iringa Region of Tanzania to learn how much they and their families were willing to pay for surgery and how "wealthy" (using ownership of several household objects as a proxy for wealth) the household was. RESULTS 60 cataract patients in Kilimanjaro and 49 in Iringa were interviewed. "Wealth" was significantly associated with willingness to pay in each region. The average expressed willingness to pay was 2457Tsh (SD 4534) or approximately $US2.30, which is far below the actual cost of providing the service. CONCLUSION There were significant differences in the expressed willingness to pay between Iringa and Kilimanjaro patients, which may reflect differences in the services provided in the regions. Willingness to pay may increase as the population gains familiarity and trust in the service. It may also be increased by ensuring that pricing is uniform and clearly advertised throughout regions and by educating health workers and counselling patients about the real costs of providing high quality surgery. Offering "free" services to all may result in lower expressed willingness to pay.
Collapse
Affiliation(s)
- S Lewallen
- Kilimanjaro Centre for Community Ophthalmology, PO Box 2254, Tumaini University/KCMC, Moshi, Tanzania.
| | | | | | | | | | | |
Collapse
|
32
|
Lewallen S, Roberts H, Hall A, Onyange R, Temba M, Banzi J, Courtright P. Increasing cataract surgery to meet Vision 2020 targets; experience from two rural programmes in east Africa. Br J Ophthalmol 2005; 89:1237-40. [PMID: 16170107 PMCID: PMC1772904 DOI: 10.1136/bjo.2005.068791] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The numbers of cataract surgeries done in sub-Saharan Africa fall short of Vision 2020 targets. Over a few years, two programmes in rural east Africa both achieved significant increases in the number of cataract surgeries they provide, resulting in cataract surgical rates of 1583 for Kwale District in Kenya and 1165 for Kilimanjaro Region in Tanzania. Key components of success in these two programmes are described. METHODS Data were collected on standard indicators and key personnel interviewed to describe the results and compare the methods employed to increase cataract surgical rates by the Kwale District Eye Centre programme and the Kilimanjaro regional Vision 2020 programme. RESULTS Key components of success shared by the programmes included: (1) programmes in the community and at the hospital are closely linked so that they increase capacity together; (2) community programmes are "patient friendly," providing service in one stop; (3) the examination team includes eye workers with enough skill to provide treatment and decide who is operable so that patients are not transported needlessly or sent through a lengthy referral chain; (4) sites for visits in the community are selected according to population distribution and they are visited according to a regular schedule. CONCLUSION The development of "bridging strategies" that create a strong link between hospitals providing clinical service and communities needing these services is a key component to realising Vision 2020 goals in sub-Saharan Africa.
Collapse
Affiliation(s)
- S Lewallen
- Kilimanjaro Centre for Community Ophthalmology, Tumaini University/KCM College, PO Box 2254, Moshi, Tanzania.
| | | | | | | | | | | | | |
Collapse
|
33
|
Mukhida K, Shilpakar SK, Sharma MR, Bagan M. Neurosurgery at Tribhuvan University Teaching Hospital, Nepal. Neurosurgery 2005; 57:172-80; discussion 172-80. [PMID: 15987553 DOI: 10.1227/01.neu.0000163429.92507.d4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 02/16/2005] [Indexed: 11/19/2022] Open
Abstract
February 6, 2005, marks the 10th anniversary of the first neurosurgical procedure performed at Tribhuvan University Teaching Hospital, one of only a few tertiary-care hospitals in Nepal. Neurosurgery began at the hospital with the arrival of an American neurosurgeon to train Nepalese surgeons locally and, later, the return of these Nepalese surgeons to Kathmandu after subsequent fellowship training in the United States. This article traces the origins of neurosurgery in Nepal, outlines the specialty's development in Kathmandu at Tribhuvan University Teaching Hospital during the past decade from international education strategies, and describes the status of and challenges facing the provision of neurosurgical care in Nepal. The role of neurosurgical services in improving the health care status of populations in developing countries is considered. Neurosurgeons in developing and developed countries alike should continue to work to remedy the inequitable distribution of neurosurgical knowledge and services throughout the world.
Collapse
Affiliation(s)
- Karim Mukhida
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | |
Collapse
|