Article
NEJM Catalyst Innovations in Care Delivery

A Cost Comparison of Cataract Surgeries in Three Countries—United States, India, and Nepal

By: Jiayin Xue, John Hinkle, Mary-Grace Reeves, Luo Luo Zheng, Vengadesan Natarajan, Shyam Vyas, Radhika Upreti Oli, Matt Oliva, Robert S. Kaplan, Arnold Milstein, Geoff Tabin, Jeffrey L. Goldberg and Kevin Schulman

Format:Electronic

Abstract

U.S.-based cataract surgeries are costly compared with those performed in high-quality Indian and Nepalese eye centers. The authors used time-driven activity-based costing to evaluate phacoemulsification surgery across four sites: a U.S.-based academic hospital outpatient department (HOPD) and an ambulatory surgery center (ASC), Aravind Eye Hospital in Pondicherry, India (AEH-P), and Tilganga Institute of Ophthalmology (TIO) in Kathmandu, Nepal. Indexing HOPD to $100 and correcting for purchasing power parity, the costs of cataract care were $42.00 at ASC, $21.50 at AEH-P, and $16.10 at TIO. Lower cost at the two South Asian sites can be attributed to faster patient throughput, avoidance of intravenous anesthesia, increased use of mid-level staff, and more frequent reuse of supplies. Adopting clinical processes from these high-quality, lower-cost providers, including a top-of-license approach that optimizes physician time; instituting detailed process flows, task-specific staffing models; and strengthening the focus on supply costs, could significantly reduce cataract surgery costs in the United States but may require new incentives within the nation’s health system.

Keywords

Time-Driven Activity-Based Costing; Cost Accounting; Health Care and Treatment; Health Industry; India; Nepal; United States

Citation

Xue, Jiayin, John Hinkle, Mary-Grace Reeves, Luo Luo Zheng, Vengadesan Natarajan, Shyam Vyas, Radhika Upreti Oli, Matt Oliva, Robert S. Kaplan, Arnold Milstein, Geoff Tabin, Jeffrey L. Goldberg, and Kevin Schulman. "A Cost Comparison of Cataract Surgeries in Three Countries—United States, India, and Nepal." NEJM Catalyst Innovations in Care Delivery 2, no. 9 (September 2021).