Cost-Effectiveness Analysis of a Regional Program for Identifying and Treating Children with Correctable Refractive Error in Indonesia

Indonesia is a rapidly growing county with over 262 million inhabitants, but among highly populated countries it has one of the lowest concentrations of eye care providers. This study evaluated the cost-effectiveness of a program implemented in South Sulawesi, Indonesia that trained school teachers to conduct vision screenings, organized in-school evaluations by opticians, and provided free eyeglasses to school children with refractive error (RE). Schoolteachers across 6 districts in South Sulawesi were trained to screen children with possible RE for subsequent evaluation by opticians. All costs associated with designing and implementing the program (administration, training personnel, labor, service delivery, etc.) were assessed. Expenditures and outcomes data were utilized to calculate the cost per disability-adjusted-life-year (DALY) averted using both 2010 and 2016 Global Burden of Disease (GBD) weights. 521 teachers screened 41,212 students across 172 schools in South Sulawesi. 4,506 (10.9%) students failed screening, 2,652 were seen by optometrists, and 2,038 received glasses. The total program cost was US$97,380, with glasses (39.6%) and labor (23.3%) accounting for the two biggest expenditures. In districts with school-based refraction services, the costs per student screened, refracted, and receiving glasses were $2.57, $31.33, and $41.40, respectively; costs were $2.04, $59.80, and $73.22 when district services were instead provided centrally. The estimated cost per DALY averted was US$89.04 based on GBD 2010 weights. Treating children with correctable RE in limited resource settings can be done cost-effectively through a school-based model.