COST-EFFECTIVENESS AND COST-UTILITY OF PREVENTING TRACHOMATOUS VISUALIMPAIRMENT - LESSONS FROM 30 YEARS OF TRACHOMA CONTROL IN BURMA

Aims/background-This paper reports on the findings of a cost and effec tiveness study of the trachoma control programme (TCP) in Burma. The T CP began in 1964 employing non-surgical interventions (community educa tion and mass treatment with topical antibiotics) and surgical correct ion of trichiasis. Methods-Fixed and variable costs of the TCP are ass essed over 30 years (1964-93) and apportioned to either surgical or no nsurgical interventions. The change in the prevalence of trachoma blin dness during this period is used to calculate cases of visual impairme nt prevented by the TCP. The years of life saved because of premature mortality averted and from living in a handicapped state are added to yield a single measure of utility called handicap adjusted life years (HALYs). Results-The cost effectiveness of the TCP is $54 per case of visual impairment prevented: $193 and $47 for surgical and non-surgica l interventions respectively. The cost utility of the TCP is $4 per HA LY averted: $10 and $3 for surgical and non-surgical interventions res pectively. Results are highly sensitive to the 1965 prevalence of blin dness, the choice of discount rate, and the effectiveness of both inte rventions. Conclusions-Thirty years of trachoma control in Burma are a ssociated with a remarkable decline in trachomatous blindness. Both su rgical and non-surgical interventions are cost effective means of prev enting trachomatous visual impairment. Discussion focuses on methodolo gical limitations and implications for research and policy.