Lessons from India: delivering high quality, efficient cataract surgery

Hong-Gam Le, M.D., who studied cataract surgery at Aravind during her second year of medical school with the nurses at Aravind eye hospital in Madurai, India. (Photo credit: Hong-Gam Le)

ANN ARBOR, Mich. – U-M Kellogg Eye Center researchers have published an inside look into India’s Aravind Eye Care System’s high efficiency effort to eliminate blindness.

Each year, Aravind hospitals provides care to nearly 4 million patients. According to the study, these efforts by the hospital to eliminate cataract-related blindness and low vision in India would cost $2.6 billion but would yield a net societal benefit of $13.5 billion.

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

“The most important lesson that I took away from Aravind Eye Care System is one of altruism,” said Hong-Gam Le, M.D., who studied cataract surgery at Aravind during her second year of medical school at U-M Medical School. “Using efficient and cost-effective strategies, Aravind is able to provide free or subsidized care to the majority of its patients. It would be wonderful if we could emulate and diffuse not only Aravind’s innovations but also their humanistic spirit to other parts of the world where access to care is still limited.”

Aravind is a network of eleven specialty eye hospitals in southern India and performs more than 400,000 eye procedures—two-thirds of which are cataract surgeries. In India, cataracts—which can be successfully treated with surgery—are a leading cause of reversible blindness.

Joshua Stein, director of the University’s Center for Eye Policy and Innovation and Hong-Gam Le who is now an ophthalmology resident at Northwestern Medicine.

“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,” said Stein.

The researchers detail 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.

“The biggest component of the cost of cataract surgery is the artificial intraocular lens. Aravind is able to keep this cost low by purchasing lenses at affordable prices from domestic manufacturers. Other countries could learn from this by creating their own manufacturers instead of importing medical supplies from Western nations,” said Le.

The study authors 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.

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

For more 20 years, Kellogg and Aravind have collaborated on clinical and health services research and Aravind leaders co-authored the analyses led by University of Michigan Kellogg Eye Center ophthalmologist Joshua Stein, M.D., and Hong-Gam Le, M.D., who is now an ophthalmology resident at Northwestern Medicine.

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 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.