The cost of the surgical treatment of cataracts at the African Institute of Tropical Ophthalmology (Bamako, Mali)

In developing countries, cataracts are a serious public health problem. There are a large number of patients, an estimated 3 millions in Africa alone, awaiting operations. However, the number of surgical interventions is small for a variety of reasons, including the cost. To try to reduce the cost of surgery, we analysed the various elements involved at the African Institute of Tropical Ophthalmology (AITO) in Bamako (Mali). The route followed by the patient, from contact with the health service through to post-operative health care was analysed in terms of individual jobs, supplies and equipment required. The unit cost of each of these elements was assessed using an adapted calculation method. The results show that the cost of the removal of the lens at the AITO is 15,200 FCFA (or $56). Installing an intra-ocular lens significantly improves the outcome for a similar cost (16,500 FCFA or $60). The relative costs of various elements were as follows: food, 32%, the suture, 12%; and equipment only 13%. Thus, to reduce the overall cost of surgery for cataracts, ambulatory surgery should be organised, with efforts to reduce the costs of suture. High quality equipment should be used, because its life-span is such that it can be amortised over a long period.