Provider-perspective cost analysis of comprehensive pediatric cataract management in a low-income setting

Childhood cataract is a leading cause of avoidable blindness in sub-Saharan Africa, but affected children rarely self-present. Therefore, programs must fund proactive case-finding and ongoing follow-up. We quantified, from a provider perspective, the costs of identification, surgery, follow-up, and rehabilitation in Kinshasa, DRC. We analyzed costs (March 2024) of a community-embedded program linked with hospital services. The pathway from screening to bilateral surgery and two-year follow-up was mapped. Costs (2024 USD) from hospital and payroll data and interviews were cross-checked regionally. A step-fixed model captured screening expansion; patient-incurred costs were excluded. The network held 32 screenings for ~ 134,400 people annually, identifying 38 children (28.3/100,000). Unit costs were $0.08 per person screened and $268.4 ± 53.7 per child (30.7%) identified; surgery $529 per child (60.5%); follow-up $77 ± 15.4 (8.8%). Average continuum cost was $875 ± 69.1 per child. Treating 38 children cost $33,245 ± 2,625.2 annually. Scaling to 1,000,000 people required eight teams, identifying 283 children at a program cost of $253,223 ± 20,678. Comprehensive pediatric cataract care is feasible at ~$875 per child when budgets include community case-finding, coordination, and follow-up alongside consumables and theatre. Volunteer-reliant case-finding and rehabilitation require funded core staff for stability. These data provide a pragmatic template for scaling programs in low-resource settings.