The Impact of Sociodemographic and Socioeconomic Factors on the Burden of Cataract in Small Island Developing States (SIDS) in the Caribbean from 1990 to 2016.

Purpose: To study the impact of sociodemographic and socioeconomic factors on the cataract burden in Caribbean small island developing states (SIDS) using disability-adjusted life-years (DALYs).Methods: National and regional age and sex specific cataract DALY numbers and rates from 1990 to 2016 for Caribbean SIDS, were extracted from the Global Burden of Disease Study 2016. The human development index (HDI), healthcare access and quality (HAQ) index, and the World Bank's classification of economies were used as socioeconomic status indicators. The Gini coefficient, Atkinson, Theil and concentration indices were used to measure health inequality. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the sociodemographic and socioeconomic factors associated with differences in cataract burden.Results: Men had higher age-standardized DALY rates than women (P < .001) with median rates of 90.72 (Interquartile range [IQR], 87.8-94.2) and 83.94(IQR, 80.9-86.5), respectively. The burden of cataract increased with age. Upper-middle income countries had higher age-standardized DALY rates than high income countries (P < .001), with median rates of 90.1 (IQR, 86.8-93.4) and 79.8 (IQR, 77.5-81.8), respectively. Age-standardized DALY rates were inversely correlated with HDI (r = - 0.61, ß = - 51.56 [P < .05]) and HAQ (r = - 0.68, ß = - 0.46 [P < .01). Between-country inequality was negligible, and the burden of cataract is greater among the poor.Conclusion: Global trends of socioeconomic factors were confirmed. Significantly, men had higher age-standardized DALY rates than women. This is an area for further research.

Trend analysis of the burden of cataract in Small Island Developing States (SIDS) in the Caribbean from 1990 to 2016

Objective: To study the trends in the burden of cataract in SIDS in the Caribbean using disability-adjusted life-years (DALYs). Design and Methodology: National and regional age and sex specific cataract DALY numbers, crude DALY rates, and agestandardised DALY rates from 1990 to 2016 for the SIDS in the Caribbean, were extracted from the Global Burden of Disease Study 2016. The human development index, healthcare access and quality (HAQ) index, and the World Bank's classification of economies were used as indicators of socioeconomic status. The Gini coefficient, Atkinson, Theil and concentration indices were used to measure health inequality. Paired Wilcoxon signed rank test, Pearson correlation, and linear regression analyses were performed to evaluate the sociodemographic and socioeconomic factors associated with differences in cataract burden. Results: Men had higher age-standardised DALY rates than women (P < 0.001) with median rates of 90.72 (Interquartile range [IQR], 87.8-94.2) and 83.94 (IQR, 80.9-86.5), respectively. The burden of cataract increased with age. Upper-middle income countries had higher age-standardised DALY rates than high income countries (P < 0.001), with median rates of 90.1 (IQR, 86.8 ­ 93.4) and 79.8 (IQR, 77.5 ­ 81.8), respectively. Age-standardised DALY rates were inversely correlated with both HDI (r = -0.61, ) and HAQ ( ). Between-country inequality was negligible and the burden of cataract is greater among the poor. Conclusions: This study confirmed the trends seen at the global level, except for the finding of men having a higher cataract burden than women in SIDS in the Caribbean. This is an area for further research.

[The role of the Fund against Catastrophic Expenditures in Health on the coverage of patients with cataract]. / El papel del Fondo de Protección contra Gastos Catastróficos en la cobertura de atención a pacientes con cataratas.

OBJECTIVE: To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. MATERIALS AND METHODS: We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. RESULTS: Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. CONCLUSIONS: Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.

El papel del Fondo de Protección contra Gastos Catastróficos en la cobertura de atención a pacientes con cataratas / The role of the Fund against Catastrophic Expenditures in Health on the coverage of patients with cataract

Objetivo. Documentar el efecto que el Fondo de Protección contra Gastos Catastróficos (FPGC) ha tenido sobre la cobertura de servicios y la disponibilidad de recursos para la atención de cataratas. Material y métodos. Con datos 2000-2010 del Sistema Automatizado de Egresos Hospitalarios y las estimaciones de población del Consejo Nacional de Población, se calcularon la tasa anual y la cobertura de atención de cataratas. Los datos de recursos proceden del Sistema Nacional de Información en Salud. Resultados. La cobertura de atención creció de 24 pacientes atendidos por 1 000 pacientes con cataratas en 2000 a 58.8 en 2012. El mayor aumento ocurrió entre 2006 y 2007 como consecuencia de la incorporación de la atención de cataratas al FPGC. Este aumento se sustenta más en la productividad por oftalmólogo que en un incremento de los recursos. Sobresalen los incrementos en la tasa de egresos observados en Aguascalientes, Coahuila, Distrito Federal y Nayarit. Conclusiones. Los resultados aquí presentados muestran beneficios sobre la salud poblacional derivados de decisiones político-organizacionales basadas en evidencias.

Objective. To describe the effect of the Fund against Catastrophic Expenditures in Health on the provision of services for patients with cataract. Materials and methods. We used administrative dataset on hospital discharges and official figures on population to estimate the rate of care and the coverage for cataract. To estimate the variation on resources, we used data from the National System of Health Information. Results. Coverage for this disease had a significant increase between 2000 and 2010, passing from 24 per thousand cataract patients receiving attention to 58.8 per thousand. This growth is mainly due to the incorporation of cataract to the catalog of diseases covered by the Fund against Catastrophic Expenditures in Health, although this variation is not based on additional resources but in a higher productivity. The growth of services is noticeable in Aguascalientes, Coahuila, Distrito Federal and Nayarit. Conclusions. Our results suggest that policy-making based on evidence have actually brought benefits for Mexican population.

Use of Global Visual Acuity Data in a time trade-off approach to calculate the cost utility of cataract surgery.

OBJECTIVE: To determine the cost utility of cataract surgery worldwide using visual acuity (VA) outcomes and utility values determined by the time trade-off (TTO) method. DATA SOURCES: Some cost data were taken from a previous search conducted for 1995 to 2006 and we searched MEDLINE and Scopus and Google for more recent data (2006 and 2007). STUDY SELECTION: Articles were identified from the literature using "cataract surgery" in combination with the terms outcome or visual acuity. Additional searches were conducted using individual countries as a term in combination with VA, outcome, or cost. Regression curves were constructed from utility values derived from a TTO study and VA data. Gains in quality-adjusted life-years (QALYs) were calculated based on life expectancy tables from the World Health Organization and discounts of 3% for both cost and benefit. Sensitivity analyses explored the effect of changes in discounting, life expectancy, preoperative VA, and cost. DATA EXTRACTION: If the data were usable, they were kept; otherwise they were discarded. DATA SYNTHESIS: Preoperative VA (logMAR) correlated with increasing gross national income per capita (Pearson correlation coefficient, -0.784; P < .001) and showed that in developing countries preoperative vision is much poorer compared with developed countries. Cost utility data ranged from $3.5 to $834/QALY in developing countries to $159 to $1356/QALY in developed countries. Sensitivity analysis showed that changing life expectancy, VA, and discount rate resulted in moderate changes. CONCLUSIONS: The TTO approach demonstrates that cataract surgery is extremely cost-effective.

Global cost-effectiveness of cataract surgery.

OBJECTIVE: To determine the cost-effectiveness of cataract surgery worldwide and to compare it with the cost-effectiveness of comparable medical interventions. DESIGN: Meta-analysis. PARTICIPANTS: Approximately 12,000 eyes in the studies selected. METHODS: Articles were identified by searching the literature using the phrase cataract surgery, in combination with the terms cost, cost-effectiveness, and cost-utility. Terms used for the comparable medical interventions search included epileptic surgery, hip arthroplasty, knee arthroplasty, carpal tunnel surgery, and defibrillator implantation. The search was restricted to the years 1995 through 2006. Cataract surgery costs were converted to 2004 United States dollars (US$). Cost-utility was calculated using: (1) costs discounted at 3% for 12 years with a discounted quality-adjusted life years (QALY) gain of 1.25 years, and (2) costs discounted at 3% for 5 years with a discounted QALY gain of 0.143 years. The Cataract Surgery Affordability Index (CSAI) for each country was calculated by dividing the cost of cataract surgery by the gross national income per capita for the year 2004. MAIN OUTCOME MEASURES: Cost-utility in 2004 US$/QALY and affordability of cataract surgery relative to the United States. RESULTS: Cost-utility values for cataract surgery (first eye) varied from $245 to $22,000/QALY in Western countries and from $9 to $1600 in developing countries. In developed countries, the cost-effectiveness of cataract surgery estimated by Choosing Interventions That Are Cost Effective ranged from, in international dollars (I$), I$730 to I$2400/disability-adjusted life years (DALY) averted, and I$90 to I$370/DALY averted in developing countries. The CSAI varied from 17% to 189% in developed countries and 29% to 133% in developing countries compared with the United States. The cost-utility of other comparable medical interventions was: epileptic surgery, $4000 to $20,000/QALY; hip arthroplasty, $2300 to $4800/QALY; knee arthroplasty, $6500 to $12,700/QALY; carpal tunnel surgery, $140 to $280/QALY; and defibrillator implantation, $700 to $23,000/QALY. CONCLUSIONS: The cost-utility of cataract surgery varies substantially, depending how the benefit is assessed and on the duration of the assumed benefit. Cataract surgery is comparable in terms of cost-effectiveness to hip arthroplasty, is generally more cost-effective than either knee arthroplasty or defibrillator implantation, and is cost-effective when considered in absolute terms. The operation is considerably cheaper in Europe and Canada compared with the United States and is affordable in many developing countries, particularly India.

Sostenibilidad financiera de la cirugía masiva de catarata: experiencia del Hospital Nacional Daniel A. Carrión - Callao 2001 / Financial sustainability of surgery massive of cataract. Experience of the National Hospital Daniel To Carrion - Callao 2001

Uno de los problemas prioritarios en la lucha contra la ceguera prevenibles es la accesibilidad económica a los servicios de salud ocular por la población más necesitada. La OMS a través de Visión 2020: la iniciativa global de lucha contra la ceguera evitable, incorpora un concepto dentro de sus lineamientos de sostenibilidad financiera de los programas de lucha contra la ceguera por catarata. Es así que en el Hospital Nacional Daniel A. Carrión del callao, con la experiencia ganada en cirugía masiva de catarata desde el año 1993, propone un modelo Predictivo de gestión de costos, a través de un sistema de economía de escala, para hacer sostenible financieramente la cirugía masiva de catarata en los hospitales públicos de nuestro país. Teniendo a puertas el inicio de un nuevo convenio entre el Hospital Nacional Daniel A. Carrión y el Club de Leones Internacional, para realizar mil cirugías gratuitas de catarata, se plantea una estrategia de compra de insumos de bajo costo y de calidad demostrada provenientes de la India (Aurolab). La experiencia de compartir insumos en forma segura, hace que se reduzcan un presupuesto de US $ 65,000 dólares para la compra de insumos de 1,000 cirugías, la estrategia de economía de escala en busca de la sostenibilidad financiera conceptúa la compra de insumos hindúes económicos a un costo unitario (por cirugía) de US $16.09 dólares, alcanzando para comprar insumos para 4.041 cirugías. El trabajo en equipo entre el Club de Leones internacional y el Hospital harán posible que con un presupuesto para insumos de 1,000 cirugías. Luego de separar insumos para las primeras 1,000 cirugías, los insumos para las 3,041 cirugías restantes, serán el fondo que dará sostenibilidad financiera a la estrategia planteada. Esto se hará través de la comercialización del kit de insumos para una catarata a una tarifa de S/. 200 nuevos soles, para los pacientes que puedan pagar (para nuestro hospital 70 por ciento), ...

Lucha contra la ceguera por cataratas en zona rural del estado Aragua: programa Sight-first / Struggle against the blindness by cataracts in the rural zone of the Aragua state: Sight-first program

Este estudio analiza un programa realizado en el Estado Aragua, Venezuela, en la lucha contra la ceguera por cataratas. Se realizó en cuatro municipios del citado estado, donde la población se caracteriza por ser de bajos recursos y baja posibilidad de atención oftalmológica. El criterio diagnóstico y terapéutico se basó en la ceguera por cataratas sin enfermedades subyacentes, en mayores de 50 años de edad. El programa consta de tres etapas: la primera incluye tamizaje y diagnóstico. Luego en la segunda, se procede a la cirugía y por último el seguimiento de los pacientes intervenidos. Tuvo una cobertura de 13,48 por ciento (989 de 7.333 habitantes). De los 989 pacientes, 80 fueron diagnosticados y operados. Estos pacientes, que eran un peso familiar y por ende condenados a una vida intradomiciliaria por no contar con los recursos para asistir al centro oftalmológico más cercano, fueron restituídos a su vida cotidiana