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David W Hutton, Hong-Gam Le, Srinivasan Aravind, Ravilla D Ravindran, Haripriya Aravind, Thulasiraj Ravilla, Rengaraj Venkatesh, Alan L Robin, Joshua D Stein; The Cost of Cataract Surgery at the Aravind Eye Hospital, India. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1289.
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The Aravind Eye Hospitals (AEH) perform high-volume cataract surgery with vision outcomes and complication rates similar or better than other well-established international centers. Details of how their processes affect costs are uncertain. We performed a detailed assessment of the costs in US dollars of a standard, uncomplicated cataract surgery by phacoemulsification in the high-volume operating rooms at the AEH in Madurai, India.
We evaluated the detailed records of all costs involved with cataract surgery at AEH. We grouped costs into the following categories: consumables, equipment, labor and overhead. Volume of patients who underwent cataract surgery at AEH in a given year was determined from records to calculate the overall cost per each surgery performed.
Total direct and indirect costs to AEH for each cataract surgery procedure in 2013 were $29.02. Patients also paid for their choice of intraocular lens. Lens costs ranged from $12.80 for an aspheric Indian (Aurolab) manufactured lens to $96.00 for an internationally-produced aspheric lens. The entry-level surgery package can be kept low because AEH uses indigenously manufactured intraocular lenses (Aurolab, an unit of Aravind Eye Care System), an item that could cost more than the procedure itself. Of the procedure costs, $6.79 were fixed costs allocated to cataract surgery and $22.23 were variable costs. The largest variable cost categories were $10.76 for consumables and $7.06 for direct labor. Labor costs were $2.25 for the surgeon and $4.81 for others. Low costs of labor are driven by the high volume of patients and efficiency of both the surgeons and the supporting staff. Depending on the choice of lens, total costs could range between $41.82 and $125.02. These overall costs are several orders of magnitude below US costs where direct ophthalmic medical costs are between $2653 and $3392. Surgeon fees alone in the US are $761 per surgery.
This is a large scale detailed analysis capturing the costs of standard, uncomplicated phacoemulsification in a high volume hospital in India. While outcomes are similar, if not better than, those in top-tier western hospitals, the costs are several orders of magnitudes lower. Cataract surgery centers in other countries could benefit from learning from the efficient and low-cost processes at AEH.
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