Cost-effectiveness analysis of child eye health interventions in India

BACKGROUND: India has 4.8 million blind persons including 250,000 blind children, and 35 million visually impaired individuals. Prevalence of blindness is 0.36%, it was 1% two decades ago due to significant public health programs towards prevention and treatment by various stakeholders. Time is opportune for cost-effectiveness analyses of these programs. There is a lack of research evidence related to quality-of-life utility values for eye health conditions in India. This study aims to develop utility values for vision impairment and conduct cost-effectiveness analysis of eye health interventions for childhood vision impairment. METHODS: Cross-sectional questionnaire-based study. 306 Children aged 4-16 years of age with unaddressed vision impairment included. Random sampling was done at a tertiary eye hospital in central India. EQ-5D-Y-3L questionnaire along with VAS score was used to measure utility measures for each of the vision impairment levels. Vision impairment was defined based on WHO classification. Mixed methods were used to collect cost data related to interventions, sensitivity analyses were performed to account for uncertainties. The protocol was approved by institutional ethics committee of university of Hyderabad (UH/IEC/2020/222). RESULTS: Median utility value of mild and moderate vision impairment is 0.8 (95% CI 0.7-0.9), severe vision impairment is 0.7 (95% CI 0.65-0.75), and for blindness is 0.55 (95% CI 0.44-0.72). Willingness to pay (WTP) is USD 2,935. ICERs for mild, moderate, severe vision impairment and blindness are USD 81, USD 367, USD 44, USD 954 respectively. CONCLUSIONS: The utility value of 0.55 for blindness correlates with existing literature. ICERs for various levels of vision impairment show the interventions to be cost-effective. There is a significant improvement in utility values post intervention. The utility measures are recommended to be used to evaluate eye health programs, and as advocacy tools for preventive eye care. KEY MESSAGES: • There is a significant improvement in utility values post-intervention and the interventions are highly cost-effective. • Important decision-making tool for allocating scarce resources to preventive eye care services.