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Ready-made and custom-made eyeglasses in India: a cost-effectiveness analysis of a randomised controlled trial
  1. Blake Angell1,
  2. Ferhina Ali2,
  3. Monica Gandhi3,
  4. Umang Mathur3,
  5. David S Friedman4,
  6. Stephen Jan5,
  7. Lisa Keay1
  1. 1 The George Institute for Global Health, University of NSW Sydney, Newtown, New South Wales, Australia
  2. 2 Wills Eye Hospital, Philadelphia, Pennsylvania, USA
  3. 3 Dr. Shroffs Charity Eye Hospital, New Delhi, India
  4. 4 Dana Center, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5 The George Institute for Global Health, University of NSW and Sydney Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Blake Angell; bangell{at}


Objective Ready-made spectacles have been suggested as a less resource-intensive treatment for the millions of people living with uncorrected refractive error (URE) in low-income environments. In spite of this interest, there have been no published economic evaluations examining the cost-effectiveness of ready-made spectacles. This study aims to determine the relative cost-effectiveness of offering ready-made spectacles (RMS) relative to no intervention as well as the relative cost-effectiveness of custom-made spectacles (CS) relative to RMS to treat URE.

Methods and analysis The relative cost-effectiveness of RMS relative to CS and no intervention was tested through a cost-effectiveness analysis from the health service provider perspective conducted alongside a double-masked randomised controlled trial in an urban hospital in Delhi, India. Participants were adults aged 18–45 years with ≥1 dioptre (D) of URE.

Results There was no significant difference between the effectiveness of the CS and RMS interventions in improving visual acuity, but the CS was over four times the price of the RMS per patient (204 INR (US$2.42) and 792 INR (US$11.22)). The cost per unit improvement in logarithm of the minimum angle of resolution (logMAR) relative to baseline with the RMS intervention was 407 INR (US$4.35). Existing estimates of utility resulting from improvements in visual acuity result in incremental cost per quality-adjusted life years gained of between 212 INR and 1137 INR (US$0.44–US$23.74) depending on the source of the utility estimate and assumed expected life of the spectacles.

Conclusion RMS represent a significantly cost-effective option for spectacle provision in low-resource settings. The RMS programme was substantially cheaper than an equivalent CS intervention while being effective in improving visual acuity for the majority of adults with refractive error in this setting. These findings provide further support for including RMS in programmes to address URE.

Trial registration number NCT00657670 , Results.

  • public health
  • optics and refraction

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  • Contributors LK and DSF conceived and oversaw the trial. FA conducted the trial with input from DSF, LK, MG and UM. UM and MG collected data. SJ and BA designed this analysis. FA and BA analysed data. BA wrote initial draft of manuscript. All authors provided input and approved the final manuscript for submission.

  • Funding Support for the trial was provided by Orbis International, New York, Dr Shroffs Charity Eye Hospital, New Delhi, Australian National Health and Medical Research Council postdoctoral fellowship (LK) and Frameworks in Global Health Award (FA).

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Johns Hopkins Medical Institutional Review Board and the Dr Shroff’s Charity Eye Hospital Human Research Ethics Committee approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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