Cost-Benefit Analysis for Universal Cataract Coverage in India for 2018

Importance Cataract is the leading cause of curable blindness in India needing scale-up of coverage. However, the costs and benefits of such scale-up remain unknown. Objective To calculate the annual scale-up costs, economic benefits of disease burden averted, and the net benefits of covering cataract needs. Design This is a retrospective cross-sectional analysis for 2018-19. Setting We look at population level data of India and its 30 states. Main Outcomes and Measures Data on cataract prevalence and disability-adjusted life-years (DALYs) was taken from the Global Burden of Disease (GBD) 2019 while cataract operations were taken from the National Health Profile (NHP) 2020. We used ten per capita surgical costs from three sources. Gross domestic product and health expenditure were taken from the National Health Accounts (2021). For the cataract scale-up costs, we calculated the total need by multiplying cataract prevalence with per capita costs and the unmet need by multiplying the difference between the prevalence and surgeries achieved with the same costs. For economic benefits of averted cataract burden, we multiplied DALYs with non-health gross domestic product, i.e., GDP minus the government health expenditure. To calculate DALYs for unmet needs we multiplied DALYs for total need with the ratio of unmet to total needs. For net benefits, we subtracted the scale-up costs for meeting total and unmet needs from economic benefits. All monetary values were adjusted for inflation and converted to USD 2020. Results The annual scale-up costs for covering total cataract needs in India were 0.92 - 4.9 billion USD. Costs for covering unmet needs were 0.72 - 3.82 billion USD. Nationally, the economic benefit of averting the total cataract disease burden was 12.4 (95%UI: 8.9 - 16.7) billion USD, while the for covering the unmet burden was 9.7 (95%UI: 6.93 - 13) billion USD. Annual net benefits of covering total needs were 7.53 - 11.5 billion USD. Net benefits of covering unmet needs were 5.9 - 9 billion USD. Net benefits varied widely across states. Conclusion and Relevance Scaling up cataract coverage is cost-beneficial. In over 90% of the scenarios considered, all Indian states have net economic benefits from the scale-up. Question What are the costs and benefits of scaling up cataract coverage in India? Findings In this cost-benefit analysis, annual scale-up costs for meeting total cataract needs in India were 0.92 to 4.9 billion USD while the annual net benefits were 7.53 to 11.5 billion USD, several folds above the costs. Meaning Universal cataract coverage is cost-beneficial to India. Further, scale-up costs form only a small percentage of the country’s gross domestic product. ### Competing Interest Statement Siddhesh Zadey represents the Association for Socially Applicable Research (ASAR) on the drafting committee of the Maharashtra State Mental Health Policy. He has previously received honoraria from Think Global Health, Harvard Public Health Magazine, and The Hindu. He is on the advisory board of ASAR and Nivarana. Other authors declare no competing interests. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes