Lifetime economic impact of pediatric cataract surgery in sub-Saharan Africa: a case study from Kinshasa

Childhood cataract is a major cause of treatable childhood blindness in sub-Saharan Africa. Effective care requires case finding, surgery, and long-term follow-up. While economic evaluations largely focus on adult cataract surgery and report high cost-effectiveness, evidence for pediatric cataract care remains limited. We built a lifetime model for bilateral pediatric cataract care, comparing discounted present values of costs and benefits with and without intervention. Costs included case finding, preoperative assessment, bilateral surgery and follow-up; benefits were expressed as age-specific productivity (GDP proxy) and quality-adjusted life years (QALYs). Parameter ranges from local program data, expert input and published sources were tested in one-way and scenario analyses. In the base case, surgery generated a present-value GDP gain of US$23,409 and 5.4 QALYs, indicating cost savings with improved quality of life. The intervention remained cost-saving across most plausible ranges; only an extreme worst-case produced a small negative GDP balance (− US$2,269) while still gaining 1.8 QALYs, remaining strongly cost-effective. Results were driven mainly by the discount rate and post-operative working-age productivity rather than surgical or follow-up costs. High-quality pediatric cataract management can therefore represent a high-return investment, but affordability constraints and uncertainty in long-term outcomes underscore the need for prospective follow-up and financial protection.