Open Access Research

Cost-effectiveness of eye care services in Zambia

Ulla K Griffiths1*, Fiammetta M Bozzani1, Adrian Gheorghe1, Lawrence Mwenge2 and Clare Gilbert3

Author Affiliations

1 Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK

2 ZAMBART Project, University of Zambia, Ridgeway Campus, Lusaka, Zambia

3 International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK

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Cost Effectiveness and Resource Allocation 2014, 12:6  doi:10.1186/1478-7547-12-6

Published: 25 February 2014



To estimate the cost-effectiveness of cataract surgery and refractive error/presbyopia correction in Zambia.


Primary data on costs and health related quality of life were collected in a prospective cohort study of 170 cataract and 113 refractive error/presbyopia patients recruited from three health facilities. Six months later, follow-up data were available from 77 and 41 patients who had received cataract surgery and spectacles, respectively. Costs were determined from patient interviews and micro-costing at the three health facilities. Utility values were gathered by administering the EQ-5D quality of life instrument immediately before and six months after cataract surgery or acquiring spectacles. A probabilistic state-transition model was used to generate cost-effectiveness estimates with uncertainty ranges.


Utility values significantly improved across the patient sample after cataract surgery and acquiring spectacles. Incremental costs per Quality Adjusted Life Years gained were US$ 259 for cataract surgery and US$ 375 for refractive error correction. The probabilities of the incremental cost-effectiveness ratios being below the Zambian gross national income per capita were 95% for both cataract surgery and refractive error correction.


In spite of proven cost-effectiveness, severe health system constraints are likely to hamper scaling up of the interventions.

Costs; Cataract; Refractive error; Presbyopia; Quality of life