Cost of cataract surgery at a provincial hospital in South Africa

Abstract

Background: Despite the high burden of cataracts, South Africa is not meeting its cataract surgery rate, mainly because of health system factors. Information on the costs involved can be beneficial in upscaling cataract surgery. Aim: To estimate the cost of cataract surgery from the health service perspective. Setting: Public-sector eye hospital in KwaZulu-Natal, South Africa. Methods: A retrospective cost analysis using a mixed costing approach was used. The study population included adult patients who had cataract surgery performed at the hospital between 01 April 2018 and 31 March 2019. An activity-based approach was used. Results: The cost for a cataract in a single eye in 2018/2019 was R4184.81 ($299.00). The highest contributor to the cost was human resources (46%), followed by equipment (19%) and medication (17%). Doctors accounted for 59% of the human resource cost, followed by nurses (24%). Theatre equipment cost accounted for 97% of the equipment cost, with two major equipment (operating microscope and phacoemulsification machine) accounting for 80% (R587.80) per patient. The medication used for anaesthesia contributed 59% (R499.04) of the medication cost. Conclusion: This is the first cost estimate of cataract surgery in the public sector in South Africa. It provides preliminary information that may be used to inform the buy-out of ophthalmology services when the National Health Insurance is implemented. Contribution: This study provides useful information on costing cataract surgery in the African setting, and the information can be used to determine how to attain cataract surgery goals in a cost-effective manner.

Keywords

• phacoemulsification
• cost analysis
• human resources
• consumables
• ophthalmologist
• public sector.