title: A Sustainable Model For Delivering High-Quality, Efficient Cataract Surgery In Southern India.
abstract: Cataracts are a leading cause of reversible blindness in India, where millions of people can be effectively treated for this condition with surgery. The Aravind Eye Care System in southern India developed an efficient system for delivering high-quality and low-cost cataract surgery. We provide a detailed accounting of costs of cataract surgery at the system and a cost-utility analysis. Total costs per operation were US$120, or $195 per quality-adjusted life-year gained. Using these data and population-based estimates of cataract prevalence, we calculate that eliminating cataract-related blindness and low vision in India would cost $2.6 billion and would yield a net societal benefit of $13.5 billion. Factors contributing to the highly cost-effective care at the Aravind Eye Care System include the domestic manufacturing of supplies, the use of a specialized workforce and standardized protocols, and the presence of few regulatory hurdles. Lessons learned from the system can help improve the delivery of cataract surgery and other ambulatory care surgeries in India and abroad.
authors.affiliation: Hong-Gam Le is a medical student at the University of Michigan Medical School, in Ann Arbor.
authors.forename: Hong-Gam
authors.initials: HG
authors.lastname: Le
authors.affiliation: Joshua R. Ehrlich is a clinical lecturer in the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, and the Institute for Healthcare Policy and Innovation, both at the University of Michigan.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Ehrlich
authors.affiliation: Rengaraj Venkatesh is chief medical officer at the Aravind Eye Hospital in Pondicherry, India.
authors.forename: Rengaraj
authors.initials: R
authors.lastname: Venkatesh
authors.affiliation: Aravind Srinivasan is an administrator at the Aravind Eye Care System, in Madurai, India.
authors.forename: Aravind
authors.initials: A
authors.lastname: Srinivasan
authors.affiliation: Ajay Kolli is an undergraduate student at the University of Michigan and a research assistant at the university's School of Public Health.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kolli
authors.affiliation: Aravind Haripriya is chief of intraocular lens and cataract services at the Aravind Eye Care System.
authors.forename: Aravind
authors.initials: A
authors.lastname: Haripriya
authors.affiliation: R. D. Ravindran is chairman and director of quality at the Aravind Eye Care System.
authors.forename: R D
authors.initials: RD
authors.lastname: Ravindran
authors.affiliation: R. D. Thulasiraj is director of operations at the Aravind Eye Care System.
authors.forename: R D
authors.initials: RD
authors.lastname: Thulasiraj
authors.affiliation: Alan L. Robin is an adjunct clinical professor in the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, at the University of Michigan; a professor in the Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, in Baltimore; and an associate professor of international health in the Johns Hopkins Bloomberg School of Public Health, also in Baltimore.
authors.forename: Alan L
authors.initials: AL
authors.lastname: Robin
authors.affiliation: David W. Hutton is an assistant professor in the Department of Health Management and Policy, School of Public Health, and Institute for Healthcare Policy and Innovation, all at the University of Michigan.
authors.forename: David W
authors.initials: DW
authors.lastname: Hutton
authors.affiliation: Joshua D. Stein (jdstein@med.umich.edu) is an associate professor in the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center; the Department of Health Management and Policy, School of Public Health; and the Institute for Healthcare Policy and Innovation, all at the University of Michigan.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D001766:Blindness / Q000453:epidemiology / Q000517:prevention & control; D002387:Cataract Extraction / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007194:India / Q000453:epidemiology; D019654:Lens Implantation, Intraocular / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years
keywords: Developing World < International/global health studies; Organization and Delivery of Care