title: Cost-effectiveness of eye care services in Zambia.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions.
authors.affiliation: Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. ulla.griffiths@lshtm.ac.uk.
authors.forename: Ulla K
authors.initials: UK
authors.lastname: Griffiths
authors.forename: Fiammetta M
authors.initials: FM
authors.lastname: Bozzani
authors.forename: Adrian
authors.initials: A
authors.lastname: Gheorghe
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mwenge
authors.forename: Clare
authors.initials: C
authors.lastname: Gilbert