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

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.