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Lessons from India: delivering high-quality, efficient cataract surgery

Study gives inside look at Aravind Eye Care System's innovative model to eliminate blindness

ANN ARBOR, Mich.University of Michigan Kellogg Eye Center researchers have published an inside look of Aravind Eye Care System’s high-efficiency effort to eliminate blindness.

In India, cataracts—which can be successfully treated with surgery—are a leading cause of reversible blindness.

Aravind is a network of eleven specialty eye hospitals in southern India, that provides care to over 3.8 million patients and performs more than 400,000 ocular procedures—two-thirds of which are cataract surgeries.

Researchers analyzed data on a sample of the 10,954 patients who visited Aravind's facilities in the city of Madurai during July 2013 and found that total costs per operation were, on average, only U.S. $120, or $195 per quality-adjusted life-year gained.

The study was published in the October issue of Health Affairs which features a cluster of articles about the quality of health care in India.

Study authors say that factors contributing to the highly cost-effective care include the domestic manufacturing of supplies, the use of a specialized workforce and standardized protocols (including operating rooms with more than one operating table per surgeon, which allows for fast transitions between operations), and the presence of few regulatory hurdles to be overcome.

Kellogg Eye Center ophthalmologist Joshua Stein, M.D., and Hong-Gam Le, M.D., an ophthalmology resident at Northwestern Medicine who studied cataract surgery at Aravind as a student at U-M Medical School, co-authored the paper with leaders at Aravind.

For more than 20 years, Kellogg and Aravind have collaborated on clinical and health services research.

World-class, low-cost care

Eliminating cataract-related blindness and low vision in India would cost $2.6 billion and would yield a net societal benefit of $13.5 billion, according to the study.

Dr. Joshua D. Stein

“One of the goals of economic analyses is to help inform (policy makers) of the value of different interventions,” says Stein, director of the University's Center for Eye Policy and Innovation and a member of the Institute for Healthcare Policy and Innovation.

“Cataract surgery can completely change the ability of a patient to be economically and socially self-sufficient and can dramatically affect quality of life of both the individual and his or her family,” he says.

The authors conclude that the lessons learned from the Aravind model can help improve delivery of cataract surgery, elsewhere in India, and abroad.

These lessons are further detailed in the issue’s People & Places report, “Lessons from Low-Cost, High Quality Eye Care,” authored by Margaret Saunders, Health Affairs deputy editor for global health.

Funding for the study was provided by W.K. Kellogg Foundation, Research to Prevent Blindness, U-M's Student Biomedical Research Program and the Heed Ophthalmic Foundation.

Additional authors include Joshua R. Ehrlich, Rengaraj Venkatesh, Aravind Srinivasan, Ajay Kolli, Aravind Haripriya, R. D. Ravindran, R. D. Thulasiraj, Alan L. Robin, and David W. Hutton.


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