Cost analysis of low vision care rehabilitative services from the perspectives of patients in India

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CLINICAL RELEVANCE: Low vision rehabilitation services are important for supporting daily functioning and quality of life. Affordability remains an important determinant of access. BACKGROUND: In low- and middle-income countries, such as India, access to low-vision rehabilitation remains limited, often due to out-of-pocket costs, despite its functional benefits. METHODS: This retrospective study analysed electronic medical records of patients attending the low vision clinic of a tertiary eye care hospital in India between November 2021 and April 2022. Patient-incurred costs were calculated for low vision diagnosis and for availing low vision clinical rehabilitation services. Diagnosis costs included outpatient consultations, diagnostic procedures, personnel, and operational expenses. Rehabilitation costs included consultation and rehabilitation services, deliverables and operational expenses. Secondary outcomes included disability-adjusted life years and loss of productivity. RESULTS: Among 1844 patient records analysed, the median age was 34 years. The median cost per patient for low vision diagnosis was 9200 Indian rupees (111 United States dollars), and for low vision clinical rehabilitation services, it was 2972 Indian rupees (36 United States dollars). Low vision interventions reduced disability-adjusted life years by 49.6% and lowered loss of productivity from 3,205,000 Indian rupees (38,791 United States dollars) to 2,064,000 Indian rupees (24,981 United States dollars) for the blind. The benefit-cost ratio for low vision clinical rehabilitation services was favourable (greater than 1). The cost for rehabilitation services was around one-fifth of the average Indian monthly income of 17,000 Indian rupees (206 United States dollars). CONCLUSIONS: Although the cost represented almost one-fifth of an average monthly income, the benefits outweigh the cost incurred by the patient. Disability-adjusted life years were reduced by half, and the provision of low vision clinical rehabilitation services was beneficial based on the benefit-cost ratio.

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