Cost-benefit analysis for universal cataract surgical coverage in India

Background Cataract is the leading cause of curable blindness in India. We estimated enhanced coverage scale-up costs, societal value of health lost to cataract, and net benefits of covering surgery needs. Methods We conducted a retrospective cross-sectional analysis for India and its 30 states. Data was taken from Global Burden of Disease 2019, National Health Profile 2020, and National Health Accounts 2021. We used ten surgery costs. Enhanced coverage costs for the total need were calculated by multiplying prevalence by costs. For unmet need, the difference between the prevalence and surgeries achieved was used. For societal value of health lost to cataract, we multiplied disability-adjusted life-years (DALYs) with non-health GDP per capita. DALYs for unmet needs were calculated by multiplying DALYs with ratio of unmet to total needs. For net benefits, enhanced coverage costs were subtracted from societal value of health lost to cataract. Results The annual national enhanced coverage costs for covering total and unmet needs were 0.92 - 4.9 and 0.72 - 3.82 billion USD, respectively. The societal value of health lost to total and unmet cataract burden was 12.4 (95% UI: 8.9 - 16.7) and 9.7 (95% UI: 6.93 - 13) billion USD, respectively. Annual net benefits of covering total needs and unmet needs were 7.53 - 11.5 and 5.9 - 9 billion USD, respectively. Conclusions Increasing coverage for cataract surgery is financially beneficial to the public health sector. This can be done through public sector service or government-funded or social health insurance expansion.