What Are The True Costs Of Treating Pediatric Cataracts? A Comparative Retrospective Cost Analysis In Norway, India And Kenya.

Our study aims to comprehensively assess the lifetime economic burden of treating pediatric cataracts. We also aim to assess the cost-effectiveness of the bag-in-the-lens technique with traditional approaches for pediatric cataract in follow-up analyses, as we have begun implenting bag-in-the-lens in all three regions studied. Global estimates of childhood blindness suggest the economic burden alone ranges from US$ 6,000 to $27,000 million, due to lost capacity of earning. In the developing world, pediatric cataract can account for as much as 10-15% of childhood blindness. Visual disabilities in children not only impede their development, but also impact their families and communities. 

Our comparative data are collected from several centers in Norway, India and Kenya. Addressing childhood cataracts poses several unique challenges, particularly in developing economies like India and Africa where resources for and acess to healthcare can be limited. However, initiatives aimed at increasing awareness, improving access to healthcare services, and providing affordable treatment options can make a substantial difference. 

A retrospective multi-centric review assessing direct costs of pediatric cataract surgery, preoperative assessment, and follow-up in select centers in Norway, Kenya and India. Data were sourced from healthcare facilities, community records, and governmental databases, employing standard costing methods. Fixed costs encompassed land, buildings, personnel, and equipment, while variable costs included consumables used during surgery. Surgical techniques varied between the regions studied, and included bag-in-the-lens (Norway) and lens-in-the-bag with anterior vitrectomy (Kenya, India). 

Our study found that the total cost of pediatric cataract surgery far exceed those reported for adults. Adult small incision cataract surgery can cost as little as 15-35 EUR per eye in some centres. In comparison, we found the total cost of pediatric cataract per child was 1329,78 EUR in Norway (of which EUR 520.96 is surgery), 387.16 EUR in Kenya (of which 104.74 EUR is surgery), and 248 EUR in India (of which 86.41 is surgery). For Kenya additional costs of 697.15 EUR must also be factored per child to establish outreach, screening and health education, bringing total costs to 1084.30 EUR per child. In Norway and India these costs are baked into existing childhood screening and education programs.

Pediatric cataract is one of the leading treatable causes of childhood blindness globally. Our study illustrates the much larger total costs necessary to successfully implement pediatric cataract treatment. The same approaches used to implement adult cataract treatments cannot be directly translated to pediatric cataract programs. The added costs associated with pediatric cataract are mainly non-surgical, and related to additional requirements such as general anesthesia, community childhood screening and education, along with often long-term postoperative care for amblyopia prevention and glaucoma detection.