Quality of Eye Care

1. Vitreoretinal surgery in Africa is seen as costly and low-yield, but no economic evaluation has ever tested that view.
2. We tested whether one is feasible, at Kabgayi Eye Unit in Rwanda, where two surgeons serve over 13 million people.
3. A total of 77 consecutive patients completed quality-of-life questionnaires before surgery and at follow-up, with no missing data.
4. Vision improved by 0.49 LogMAR, and patients regained face recognition, independent mobility, income and caregiving roles.
5. The generic EQ-5D barely moved while the vision-specific measure showed clear gains, so vision-specific tools are needed to capture the true value of this surgery.

Investment in vitreoretinal surgery in sub-Saharan Africa is limited by the perception of high cost and poor benefit, yet no economic evaluation exists to inform policy. We carried out a prospective cost-consequence analysis of the vitreoretinal service at Kabgayi Eye Unit, Rwanda, enrolling 77 consecutive adults between October 2024 and January 2025. Health-related and vision-related quality of life were measured before surgery and at final follow-up (mean 6.5 weeks, range 2 to 17) using the EQ-5D-3L and the Edwards-Davies questionnaire, a new measure designed for African settings, and costs were estimated from national insurance tariffs.

All 77 patients completed both questionnaires at both time points, with no missing data. Mean visual acuity improved by 0.49 LogMAR (p<0.001). The EQ-5D-3L index rose by 0.03 (p=0.186), equal to 0.10 QALYs gained during follow-up, with a ceiling effect in about a quarter of patients, while the EQ-5D VAS rose by 5.8 points (p=0.004). The Edwards-Davies measure showed consistent gains in daily function, income-earning ability and emotional wellbeing, including a 45 percentage point fall in patients strongly agreeing they felt sad about their vision. The tariff-based cost of a vitrectomy was about £164 to £246.

This is the first economic evaluation of a vitreoretinal service in sub-Saharan Africa. It shows that collecting patient-reported outcomes is feasible and that vision-specific measures may be more sensitive to early benefit than generic ones. These data provide the foundation for lifetime cost-effectiveness models to guide investment and training.