Economic analysis of corneal ulcers in South India

Abstract

Purpose: To estimate the costs of treating corneal ulcers at a tertiary eye care center in south India from a patient perspective.

Methods: A prospective cohort study design at a tertiary eye care center in south India. Each subject presenting with corneal ulcers to the center had a detailed clinical and laboratory workup including slit-lamp biomicroscopy, direct smear examination with appropriate stains, and cultures. Data on direct costs including costs of consultation, studies to confirm diagnosis, and treatment were collected at baseline and follow-up visits. We also collected indirect costs including travel, accommodation, food, and loss of wages of both the subject and accompanying persons.

Results: We recruited 498 consecutive cases for the study. The mean duration of onset of symptoms before presentation at the cornea service was 13.1 +/- 19.9 days. The mean follow-up duration was 34.8 +/- 28.2 days. The total overall cost for accessing and receiving care was 85.8 US dollars +/- 4.6 (95% confidence interval: 76.4 US dollars, 94.6). The mean total cost to diagnose and appropriately treat 1 case of keratitis such that the patient had vision better than 6/18 at final follow-up was 56.2 US dollars +/- 3.6 (95% confidence interval: 49.0 US dollars, 63.3).

Conclusions: : The costs to the patient to receive appropriate care for corneal ulcers in this population are much higher than the average monthly wage for this population. There is an urgent need to devise strategies that may help reduce costs of care for corneal ulcers in this population.