Cost-minimisation Analysis from a Non-inferiority Trial of Ready-Made versus Custom-Made Spectacles for School Children in India

ABSTRACT

Purpose: Uncorrected refractive error is the leading cause of visual impairment in children. Many countries, including India, implement school eye health programmes involving vision screening and provision of free spectacles. This is costly for governments/organisations involved. This analysis estimates potential cost-savings if ready-made spectacles, in addition to traditional custom-made spectacles, are available for dispensing in school eye health programmes.

Methods: An economic evaluation was conducted alongside a randomised controlled trial comparing spectacle wear of ready-made spectacles versus custom-made spectacles for children aged 11–15 years in schools in India. A cost-minimisation approach was used to calculate cost-savings of a ‘ready-made spectacles available’ programme compared with a ‘custom-made spectacles only’ school programme. The analysis was from a service provider perspective. Main outcomes: cost-saving per child needing spectacles and cost-saving per 1000 children screened.

Results: The prevalence of uncorrected refractive error was 2.23%, and 86% of children were eligible for ready-made spectacles. The cost per child needing spectacles in a custom-made spectacles only programme was USD$26.91, and in a ready-made spectacles available programme was $11.15, producing a 58.6% cost-saving per child needing spectacles of $15.76. Considering the total cost of the eye health programme, this equated to a 15.1% cost-saving per 1000 children screened of $361. Results were robust to multivariate sensitivity analyses.

Conclusion: Our study is the first to demonstrate the significant cost-saving potential of ready-made spectacles in school eye health programmes for uncorrected refractive error compared with custom-made spectacles alone. This has substantial economic benefits for national/international programmes.

KEYWORDS:

• School eye health; refractive error; ready-made spectacles; cost-minimisation

Acknowledgments

We would like to thank Dr Kaushik and his team at the Sankara Eye Hospital. We would also like to thank the Vision Impact Institute and Essilor for donation of the spectacles used in the trial. The donor played no role in the design, conduct, analysis, or interpretation of the results of the study.

Ethics approval

The trial and cost-analysis were approved by the Interventions and Research Ethics Committee of the London School of Hygiene & Tropical Medicine, and the institutional review board of Sankara Eye Hospital.

Additional information

Funding

Support for the trial was provided by L'Occitane Foundation or Fondation L'Occitane; Vision Impact Institute.

Notes on contributors

Priya Morjaria

PM and CG conceived and oversaw the trial. PM and NM collected data. NM designed this cost-analysis with input from PM, KF, and CG. NM analysed the data. NM wrote the initial draft of the manuscript. All authors provided input and approved the final manuscript for submission. NM and PM had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.