Analysis of costs and benefits of the Gambian Eye Care Program

Objective: To estimate the net benefit of the Gambian Eye Care Program (GECP) using a limited definition of benefits from a societal perspective. Methods: The number of cases of blindness avoided was modeled using population projections, population-based blindness survey estimates from 1986 and 1996, and reported blindness-related mortality differences. Benefits were measured as lifetime productivity gains that resulted from the cases of blindness avoided between the surveys. Costs included all contributions to GECP between the surveys. Results: In 1996, 1658 fewer individuals were blind than would have been without GECP. The present value of costs was US $1.28 million (1995 dollars). Although the net benefit between the blindness surveys was negative, the net lifetime benefit was US $1.01 million (1995 dollars), yielding an internal rate of return of 10%. In the primary sensitivity analysis, assuming similar benefits to Senegalese citizens, who accounted for 30% of patients, the internal rate of return was 19%. Upper bound sensitivity analyses result in internal rates of return higher than 20%. Conclusion: In one sub-Saharan African country with avoidable blindness due to cataract and eye infections, the internal rate of return of a national eye care program was substantial when using a limited definition of benefit.