Cost-consequence analysis and patient-reported outcomes of vitreoretinal surgery in Rwanda: a health economics feasibility study

BACKGROUND: Investment in vitreoretinal (VR) surgery in sub-Saharan Africa (SSA) is constrained by perceptions of high cost and
limited benefit, yet no economic evaluations exist to inform policy decisions. This study assessed the feasibility of conducting
economic evaluation of VR surgery in Rwanda.
METHODS: A cost-consequence analysis of a VR service at a tertiary eye hospital in Rwanda was conducted. Data on clinical
outcomes and broader health impacts were collected for consecutive patients undergoing surgery. Health-related (HRQoL) and
vision-related quality-of-life (VRQoL) were assessed pre-and postoperatively via the EQ-5D-3L and Edwards-Davies questionnaires.
Surgical costs were estimated using national insurance tariffs.
RESULTS: Seventy-seven patients were prospectively enrolled between October 2024 and January 2025. The most common
indications for surgery were retinal detachment (26%), macular hole (25%) and vitreous haemorrhage (14%). All 77 patients
completed follow-up at 2–17 weeks postoperatively (mean: 6.5 weeks). Mean visual Acuity (VA) improved by –0.49 LogMAR
(p < 0.001). Mean increase in EQ-5D-3L index score was 0.03 (p = 0.186), corresponding to 0.10 Quality-Adjusted Life Years (QALYs)
(95% Confidence Interval (CI): 0.09, 0.11) accrued during follow-up; mean EQ-5D Visual Analogue Scale (VAS) scores increased by 5.8
points (p = 0.004). The Edwards-Davies measure showed consistent improvements in functional domains, including recognising
faces, navigating independently, and earning income.
CONCLUSIONS: This study provides the first economic evaluation of a VR service in SSA and demonstrates the feasibility of using
PROMs to assess HRQoL and VRQoL in this setting. Vision-specific PROMs may be more sensitive to early functional and mental
wellbeing improvements following VR surgery than more generic PROMs.