Comparative Cost-Effectiveness of Fixed and Mobile Primary Eye Health Services

There is limited cost-effectiveness evidence of primary eye health strategies in low-and-middle-income countries, despite their importance for addressing vision loss. This study examines fixed and mobile primary eye health services in Guatemala to identify which delivers greatest cost-effectiveness.

Using financial records of a large eye health provider, we conduct a retrospective micro-costing and economic modelling analysis of five primary eye health approaches. We report total costs, case finding cost-effectiveness, and incremental cost-effectiveness ratios (ICERs) for each strategy from a provider perspective over the period 2019-2021. Probabilistic sensitivity analysis is conducted.

Permanent facilities require $71.7 and $116.8 (2023 USD) to diagnose a case of refractive error and cataract respectively, and convert the patient to treatment. Case finding costs per treatment initiated for mobile approaches range from $7.7 to $21.6 per case of refractive error, and $13.3-$14.9 per case of cataract. Health outpost screening has an ICER of $245 per DALY averted (95% CI: 160-362). The ICER of community screening is $233 per DALY averted (95% CI: 134-316). The remaining strategies are dominated.

Mobile approaches are substantially more cost-effective at case finding, due to the increased utilization of resources made possible by a mobile operating model. When considering both case finding and downstream treatment costs, community and health outpost screening dominate other strategies. The results point to the need for careful analysis of costs and outcomes along the entire continuum-of-care to appropriately inform planners of primary eye health networks in low-and-middle-income countries.