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Ginel J, Burguera N, Piñero D, Sáez-Martín A, Haro De Rosario A, Fernández J. Economic evaluations in cataract surgery: a narrative review. Eye (Lond) 2024; 38:1418-1424. [PMID: 38347178 PMCID: PMC11126667 DOI: 10.1038/s41433-024-02965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/07/2023] [Accepted: 01/26/2024] [Indexed: 05/26/2024] Open
Abstract
Economic evaluations are tools for assessing emerging technologies and a complement for decision-making in healthcare systems. However, this topic may not be familiar for doctors and academics, who may be confused when interpreting the results of studies using these tools. Cataract is a disease which has received special attention in healthcare systems due to its high incidence, the great impact that it could have on patients' quality of life, and the fact that it can be definitively solved in almost all cases through cataract surgery. Historically, economic evaluations in cataract surgery have been conducted for many purposes by simply assessing whether the surgery is cost-effective for specific questions related to the implantation of multifocal intraocular lenses, surgical techniques, optimizing assessments, preventing diseases or complications, etc. Moreover, although there are systematic reviews about cataract surgery and narrative reviews introducing the concept of economic evaluations, as far as we know, no previous study has been conducted that synthesizes and integrates evidence coming from both fields. Thus, the purpose of this narrative review is to introduce doctors and academics to economic evaluation tools, to describe how these have been historically applied to cataract surgery, and to provide special considerations for the correct interpretation of economic studies.
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Affiliation(s)
- José Ginel
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain.
| | - N Burguera
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
| | - D Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain
- Department of Ophthalmology (IMQO-Oftalmar), Vithas Medimar International Hospital, Alicante, Spain
| | - A Sáez-Martín
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - A Haro De Rosario
- Department of Economics and Business, Faculty of Economics and Business Studies, University of Almería, Ctra. Sacramento s/n, La Cañada de San Urbano, 04120, Almería, Spain
| | - J Fernández
- Qvision, Department of Ophthalmology of VITHAS Almería Hospital, 04120, Almería, Spain
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Economic Evaluation of Cataract: A Systematic Mapping Review. Ophthalmol Ther 2023; 12:789-807. [PMID: 36809595 PMCID: PMC10011294 DOI: 10.1007/s40123-023-00678-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION The purpose of this article was to ascertain the existing literature and find the gaps in economic evaluations of cataracts. METHODS Systematic methods were used to search and collect the published literature on economic evaluations of cataracts. A mapping review of studies published in the following bibliographical databases was performed: the National Library of Medicine (PubMed), EMBASE, Web of Science (WOS), and the Central of Reviews and Dissemination (CRD) database. A descriptive analysis was conducted and relevant studies were classified into different groups. RESULTS Among 984 studies screened, 56 studies were included in the mapping review. Four research questions were answered. There has been a progressive increase of publications during the last decade. The majority of the included studies were published by authors from institutions in the USA and UK. The most commonly investigated area was cataract surgery followed by intraocular lenses (IOLs). The studies were classified into different categories according to the main outcome evaluated, such as comparisons between different surgical techniques, costs of the cataract surgery, second eye cataract surgery costs, quality of life gain after cataract surgery, waiting time of cataract surgery and costs, and cataract evaluation, follow-up, and costs. In the IOL classification, the most frequently studied area was the comparison between monofocal and multifocal IOLs, followed by the comparison between toric and monofocal IOLs. CONCLUSIONS Cataract surgery is a cost-effective procedure compared with other non-ophthalmic and ophthalmic interventions and surgery waiting time is an important factor to consider because vision loss has a huge and broad-ranging impact on society. Numerous gaps and inconsistencies are found among the studies included. For this reason, there is a need for further studies according to the classification described in the mapping review.
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Wong B, Singh K, Khanna RC, Ravilla T, Kuyyadiyil S, Sabherwal S, Sil A, Dole K, Chase H, Frick KD. Strategies for cataract and uncorrected refractive error case finding in India: Costs and cost-effectiveness at scale. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 7:100089. [PMID: 37383934 PMCID: PMC10305965 DOI: 10.1016/j.lansea.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Background India has the largest number of individuals suffering from visual impairment and blindness in the world. Recent surveys indicate that demand-based factors prevent more than 80% of people from seeking appropriate eye services, suggesting the need to scale up cost-effective case finding strategies. We assessed total costs and cost-effectiveness of multiple strategies to identify and encourage people to initiate corrective eye services. Methods Using administrative and financial data from six Indian eye health providers, we conduct a retrospective micro-costing analysis of five case finding interventions that covered 1·4 million people served at primary eye care facilities (vision centers), 330,000 children screened at school, 310,000 people screened at eye camps and 290,000 people screened via door-to-door campaigns over one year. For four interventions, we estimate total provider costs, provider costs attributable to case finding and treatment initiation for uncorrected refractive error (URE) and cataracts, and the societal cost per DALY averted. We also estimate provider costs of deploying teleophthalmology capability within vision centers. Point estimates were calculated from provided data with confidence intervals determined by varying parameters probabilistically across 10,000 Monte Carlo simulations. Findings Case finding and treatment initiation costs are lowest for eye camps (URE: $8·0 per case, 95% CI: 3·4-14·4; cataracts: $13·7 per case, 95% CI: 5·6-27·0) and vision centers (URE: $10·8 per case, 95% CI: 8·0-14·4; cataracts: $11·9 per case, 95% CI: 8·8-15·9). Door-to-door screening is as cost-effective for identifying and encouraging surgery for cataracts albeit with large uncertainty ($11·3 per case, 95% CI: 2·2 to 56·2), and more costly for initiating spectacles for URE ($25·8 per case, 95% CI: 24·1 to 30·7). School screening has the highest case finding and treatment initiation costs for URE ($29·3 per case, 95% CI: 15·5 to 49·6) due to the lower prevalence of eye problems in school aged children. The annualized cost of operating a vision center, excluding procurement of spectacles, is estimated at $11,707 (95% CI: 8,722-15,492). Adding teleophthalmology capability increases annualized costs by $1,271 per facility (95% CI: 181 to 3,340). Compared to baseline care, eye camps have an incremental cost-effectiveness ratio (ICER) of $143 per DALY (95% CI: 93-251). Vision centers have an ICER of $262 per DALY (95% CI: 175-431) and were able to reach substantially more patients than any other strategy. Interpretation Policy makers are expected to consider cost-effective case finding strategies when budgeting for eye health in India. Screening camps and vision centers are the most cost-effective strategies for identifying and encouraging individuals to undertake corrective eye services, with vision centers likely to be most cost-effective at greater scale. Investment in eye health continues to be very cost-effective in India. Funding The study was funded by the Seva Foundation.
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Affiliation(s)
- Brad Wong
- Mettalytics, New South Wales, Australia
| | | | - Rohit C. Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute, Hyderabad, India
| | - Thulasiraj Ravilla
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Subeesh Kuyyadiyil
- Sadguru Netra Chikitsalaya, Shri Sadguru Seva Sangh Trust Chitrakoot, India
| | | | - Asim Sil
- Vivekananda Mission Asram Netra Niramay Niketan, West Bengal, India
| | - Kuldeep Dole
- Poona Blind Men's Association, HV Desai Eye Hospital, Pune, Maharashtra, India
| | | | - Kevin D. Frick
- Johns Hopkins Carey Business School, Baltimore, USA
- Johns Hopkins Bloomberg School of Public Health, Departments of Health Policy and Management and International Health; Johns Hopkins University, School of Medicine Department of Ophthalmology, USA
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Shehata M, Aly MOM, Saleh MGA, Abdel-Radi M. Twelve month outcome of manual small-incision cataract surgery in Assiut, Egypt: A retrospective study with a large sample size. Oman J Ophthalmol 2022; 15:326-330. [PMID: 36760935 PMCID: PMC9905918 DOI: 10.4103/ojo.ojo_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 06/11/2022] [Accepted: 07/04/2022] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND To assess the visual outcome of manual small-incision cataract surgery (MSICS) as well as safety, cost, and time of the procedure. PATIENTS AND METHODS A retrospective study involving candidates for cataract surgery with baseline-corrected distance visual acuity (CDVA) ≤20/120. Visual acuity (VA) was the primary outcome measure while surgical complications, cost, and time of surgery were the secondary outcome measures. Follow-up visits were scheduled at 1 day, 1 week, 1 month, and at 6 and 12 months following surgery. RESULTS The study enrolled 3007 patients with a mean age of 66.45 ± 17.3 years. Out of 3007 patients, 2774 (92.2%) were legally blind before surgery (CDVA <20/200) which was significantly reduced to 55 patients (1.9%) by 1 month following surgery. Uncorrected distance visual acuity was 20/60 or better in 2098 eyes (69.8%) at 1 month, in 2035 eyes (67.7%) at 6 months, and in 2017 eyes (67.1%) at 12 months. The posterior capsular rupture was the most common intraoperative complication. Corneal edema was the most common immediate postoperative complication while the development of posterior capsular opacification was the leading cause for later impaired VA. The mean cost was approximately equivalent to 20 US dollars. The median duration of surgery was 10 min. CONCLUSION MSICS is a safe, cost-effective, and time-saving technique for improving the vision of cataract patients in areas with high cataract surgery volume and limited facilities.
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Affiliation(s)
- Mohamed Shehata
- Department of Ophthalmology, Assiut University, Assiut, Egypt
| | | | | | - Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University, Assiut, Egypt,Address for correspondence: Dr. Mahmoud Abdel-Radi, Department of Ophthalmology, 6th Floor, Assiut University Hospital, Assiut University, Assiut, Egypt. E-mail:
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Bali J, Bali O, Sahu A, Boramani J, Deori N. Health economics and manual small-incision cataract surgery: An illustrative mini review. Indian J Ophthalmol 2022; 70:3765-3770. [PMID: 36308093 PMCID: PMC9907292 DOI: 10.4103/ijo.ijo_1266_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cataract extraction is one of the most common surgical procedures performed worldwide. Manual small-incision cataract surgery (MSICS) is a popular technique of cataract extraction. Full economic evaluation of different techniques is of value to policy makers. This was a systematic review of published literature to present a brief overview of evidence available in respect of economic evaluation measures like cost effectiveness, cost utility, and cost parameters in cataract patients regarding MSICS. The data on these was sparse and heterogeneous. Direct costs of MSICS were lower than phacoemulsification (PE): $25.55 (PE) to $17.03 (MSICS) in India, $15 (MSICS) to $70 (PE) in Nepal, and $62.25 (MSICS) to $104.15 (PE) in Thailand. The cost utility analysis for MSICS demonstrated savings of $79.57 (INR6175) per gain in LogMAR BCVA, $8.91 (INR691) per QALY gained and $1.42 (INR110) per VF 14 score increment in India. Incremental cost-effectiveness ratio (ICER) $368.20 (13,215.50 Baht) for MSICS was better than $489.30 (17,561.70 Baht) for PE in Thailand. ICER for femto laser-assisted cataract surgery (FLACS) compared to was €10,703 in femtosecond laser-assisted versus phacoemulsification cataract surgery (FEMCAT) study. The corrected ICER for PE against MSICS is €146.50. The limited data available demonstrates that MSICS is the most cost-effective technique among FLACS, PE, and MSICS. MSICS scores over other existing alternatives of cataract extraction from cost-effectiveness and cost-minimization approaches. Further research is required in this area.
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Affiliation(s)
- Jatinder Bali
- Ophthalmologist In-Charge, Narela Polyclinic, North Delhi Municipal Corporation, Delhi, India,Correspondence to: Dr. Jatinder Bali, 55-D, Third Floor, DDA Flats, Kalidas Road, Gulabibagh, Delhi - 110 007, India. E-mail:
| | | | - Amulya Sahu
- Sahu Eye Hospital and Kamal Nethralay Pvt Ltd, Mumbai, Maharashtra, India
| | - Jagannath Boramani
- Surya Netralaya, Vashi, Navi Mumbai, Maharashtra, India,MGM’s New Bombay Hospital, Vashi, Navi Mumbai, Maharashtra, India
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Sinha A, Gurnani B, Kaur K, Niharika J, Bejjenki P, Venkatesh D, Morya AK. Commentary: Surgically induced astigmatism in manual small-incision cataract surgery incision types: Is the correlation linear? Indian J Ophthalmol 2022; 70:3869-3870. [PMID: 36308116 PMCID: PMC9907283 DOI: 10.4103/ijo.ijo_2235_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Bharat Gurnani
- Cataract, Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - J Niharika
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Priyanka Bejjenki
- All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Dharavath Venkatesh
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Telangana, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India,Correspondence to: Dr. Arvind Kumar Morya, Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana, India. E-mail:
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Tejaswini A, Gurnani B, Kaur K, Sinha A, Bejjenki P, Jella N, Morya AK. Commentary: Evaluating affordability, cost-effectiveness, cost-utility, health economics, and incremental cost-effectiveness ratio of manual small-incision cataract surgery - The need of the hour. Indian J Ophthalmol 2022; 70:3771-3772. [PMID: 36308094 PMCID: PMC9907234 DOI: 10.4103/ijo.ijo_2232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Antarvedi Tejaswini
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Bharat Gurnani
- Cataract, Cornea, External Disease, Trauma, Ocular Surface and Refractive Surgery, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | - Kirandeep Kaur
- Cataract, Pediatric Ophthalmology and Strabismus, Dr. Om Parkash Eye Institute, Amritsar, Punjab, India
| | | | - Priyanka Bejjenki
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Niharika Jella
- Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Arvind Kumar Morya
- Cataract, Glaucoma, Refractive, Squnt, Paediatric Ophthalmology and Medical Retina Services, All India Institute of Medical Sciences Bibinagar, Hyderabad, Telangana, India,Correspondence to: Dr. Arvind Kumar Morya, Cataract, Glaucoma, Refractive, Squint, Pediatric Ophthalmology and Medical Retina Services, Department of Ophthalmology, All India Institute of Medical Sciences, Bibinagar, Hyderabad - 508 126, Telangana, India. E-mail:
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8
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Du YF, Liu HR, Zhang Y, Bai WL, Li RY, Sun RZ, Wang NL. Prevalence of cataract and cataract surgery in urban and rural Chinese populations over 50 years old: a systematic review and Meta-analysis. Int J Ophthalmol 2022; 15:141-149. [PMID: 35047369 PMCID: PMC8720354 DOI: 10.18240/ijo.2022.01.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To summarize the data of epidemiological studies on cataract prevalence over 50 years old in urban and rural areas of China from 2000 to 2020, and to analyze the prevalence of cataract and operation rate in China. METHODS By searching PubMed, EMBASE, Web of Science, Wanfang Data and CNKI, Chinese and English literatures on the prevalence of cataract in China were retrieved, and the relevant characteristic data were extracted. Then, Stata v15SE software was used for Meta-analysis and heterogeneity test. According to the results of heterogeneity, the corresponding effect models were selected to combine the extracted data. RESULTS A total of 20 studies were included in this study, with a total of 111 434 cases. Meta-analysis showed heterogeneity. According to the random effect model, the overall prevalence of cataract in Chinese people over 50 years old was 27.45%, that in rural was 28.79%, and that in urban was 26.66%. The overall coverage rate of cataract surgery was 9.19%. CONCLUSION The prevalence of cataract is high in China, and there is still room for improvement in surgical coverage, so it is very important to promote cataract screening and prevention.
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Affiliation(s)
- Yi-Fan Du
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Han-Ruo Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Yue Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Wei-Ling Bai
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Ru-Yue Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Run-Zhou Sun
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
| | - Ning-Li Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing 100730, China
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Khurana T, Gupta A, Rathi H. The state of cost-utility analysis in India: A systematic review. Perspect Clin Res 2021; 12:179-183. [PMID: 34760643 PMCID: PMC8525785 DOI: 10.4103/picr.picr_256_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022] Open
Abstract
Aims: Cost-utility studies are crucial tools that help policy-makers promote appropriate resource allocation. The objective of this study was to evaluate the extent and quality of cost-utility analysis (CUA) in India through a systematic literature review. Methods: Comprehensive database search was conducted to identify the relevant literature published from November 2009 to November 2019. Gray literature and hand searches were also performed. Two researchers independently reviewed and assessed study quality using Consolidated Health Economic Evaluation Reporting Standards checklist. Results: Thirty-five studies were included in the final review. Thirteen studies used Markov model, five used decision tree model, four used a combination of decision tree and Markov model and one each used microsimulation and dynamic compartmental model. The primary therapeutic areas targeted in CUA were infectious diseases (n = 12), ophthalmology (n = 5), and endocrine disorders (n = 4). Five studies were carried out in Tamil Nadu, four in Goa, three in Punjab, two each in Delhi, Maharashtra, and Uttar Pradesh, and one each in West Bengal and Karnataka. Twenty-three, eight, and four studies were found to be of excellent, very good, and good quality, respectively. The average quality score of the studies was 19.21 out of 24. Conclusions: This systematic literature review identified the published CUA studies in India. The overall quality of the included studies was good; however, features such as subgroup analyses and explicit study perspective were missing in several evaluations.
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Affiliation(s)
- Tanu Khurana
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Amit Gupta
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India
| | - Hemant Rathi
- Health Economics and Outcomes Research, Skyward Analytics Private Limited, Gurgaon, Haryana, India.,Health Economics and Outcomes Research, Skyward Analytics Pte. Limited Singapore, Singapore
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10
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Wong YL, Noor M, James KL, Aslam TM. Ophthalmology Going Greener: A Narrative Review. Ophthalmol Ther 2021; 10:845-857. [PMID: 34633635 PMCID: PMC8502635 DOI: 10.1007/s40123-021-00404-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022] Open
Abstract
The combined effects of fossil fuel combustion, mass agricultural production and deforestation, industrialisation and the evolution of modern transport systems have resulted in high levels of carbon emissions and accumulation of greenhouse gases, causing profound climate change and ozone layer depletion. The consequential depletion of Earth's natural ecosystems and biodiversity is not only a devastating loss but a threat to human health. Sustainability-the ability to continue activities indefinitely-underpins the principal solutions to these problems. Globally, the healthcare sector is a major contributor to carbon emissions, with waste production and transport systems being amongst the highest contributing factors. The aim of this review is to explore modalities by which the healthcare sector, particularly ophthalmology, can reduce carbon emissions, related costs and overall environmental impact, whilst maintaining a high standard of patient care.
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Affiliation(s)
- Yee Ling Wong
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Maha Noor
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Katherine L James
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Tariq M Aslam
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,School of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Kauser F, Amitava AK, Saxena J, Raza SA, Masood A. Economizing strabismus surgery: Using half the double-armed suture for horizontal muscles. Indian J Ophthalmol 2021; 69:1945-1947. [PMID: 34146063 PMCID: PMC8374764 DOI: 10.4103/ijo.ijo_2869_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In a developing country like India, both availability and affordability of medical care are obstacles, leading to delay in seeking timely treatment. To reduce the cost incurred to the patients for strabismus surgery, we used half of a 6-0 polyglactin suture for performing common muscle weakening and strengthening procedures: a fixed and hang back recessions with plication and resection. We cut the 45-cm-long double-armed 6-0 polyglactin sutures in two halves, and with a modified approach, used one-half in each of two patients planned for monocular two horizontal muscles surgeries: fixed recession-plication and hang back recession-resection. By devising an intuitive manner of threading a single armed 22.5 cm suture we successfully carried out horizontal extraocular muscle surgeries on each of two patients of exotropia. We believe in the long run, this will reduce the cost to individual patients and sponsoring groups, and suggest that strabismus surgeons consider adopting this option.
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Affiliation(s)
- Farnaz Kauser
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Abadan K Amitava
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Juhi Saxena
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - S Aisha Raza
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Anam Masood
- Institute of Ophthalmology, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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12
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Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, Ah Tong BAM, Arunga S, Bachani D, Bascaran C, Bastawrous A, Blanchet K, Braithwaite T, Buchan JC, Cairns J, Cama A, Chagunda M, Chuluunkhuu C, Cooper A, Crofts-Lawrence J, Dean WH, Denniston AK, Ehrlich JR, Emerson PM, Evans JR, Frick KD, Friedman DS, Furtado JM, Gichangi MM, Gichuhi S, Gilbert SS, Gurung R, Habtamu E, Holland P, Jonas JB, Keane PA, Keay L, Khanna RC, Khaw PT, Kuper H, Kyari F, Lansingh VC, Mactaggart I, Mafwiri MM, Mathenge W, McCormick I, Morjaria P, Mowatt L, Muirhead D, Murthy GVS, Mwangi N, Patel DB, Peto T, Qureshi BM, Salomão SR, Sarah V, Shilio BR, Solomon AW, Swenor BK, Taylor HR, Wang N, Webson A, West SK, Wong TY, Wormald R, Yasmin S, Yusufu M, Silva JC, Resnikoff S, Ravilla T, Gilbert CE, Foster A, Faal HB. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health 2021; 9:e489-e551. [PMID: 33607016 PMCID: PMC7966694 DOI: 10.1016/s2214-109x(20)30488-5] [Citation(s) in RCA: 478] [Impact Index Per Article: 159.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ana Patricia Marques
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rupert R A Bourne
- Vision and Eye Research Institute, Anglia Ruskin University, Cambridge, UK; Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK; Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | | | | | - Simon Arunga
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Department of Ophthalmology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Damodar Bachani
- John Snow India, New Delhi, India; Ministry of Health and Family Welfare, New Delhi, India
| | - Covadonga Bascaran
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Peek Vision, London, UK
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Tasanee Braithwaite
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; The Medical Eye Unit, St Thomas' Hospital, London, UK
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chimgee Chuluunkhuu
- Orbis International, Ulaanbaatar, Mongolia; Mongolian Ophthalmology Society, Ulaanbaatar, Mongolia
| | | | | | - William H Dean
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Alastair K Denniston
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK; Ophthalmology Department, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK; Health Data Research UK, London, UK
| | - Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Paul M Emerson
- International Trachoma Initiative and Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Kevin D Frick
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - David S Friedman
- Massachusetts Eye and Ear, Harvard Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - João M Furtado
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | | | - Reeta Gurung
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Esmael Habtamu
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Eyu-Ethiopia Eye Health Research, Training, and Service Centre, Bahirdar, Ethiopia
| | - Peter Holland
- International Agency for the Prevention of Blindness, London, UK
| | - Jost B Jonas
- Institute of Clinical and Scientific Ophthalmology and Acupuncture Jonas and Panda, Heidelberg, Germany; Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Pearse A Keane
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Rohit C Khanna
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, LV Prasad Eye Institute, Hyderabad, India; Brien Holden Eye Research Centre, LV Prasad Eye Institute, Hyderabad, India
| | - Peng Tee Khaw
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatima Kyari
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Van C Lansingh
- Instituto Mexicano de Oftalmologia, Queretaro, Mexico; Centro Mexicano de Salud Visual Preventiva, Mexico City, Mexico; Help Me See, New York, NY, USA
| | - Islay Mactaggart
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Milka M Mafwiri
- Department of Ophthalmology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Priya Morjaria
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lizette Mowatt
- University Hospital of the West Indies, Kingston, Jamaica
| | - Debbie Muirhead
- The Fred Hollows Foundation, Melbourne, Australia; Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Gudlavalleti V S Murthy
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Indian Institute of Public Health, Hyderabad, India
| | - Nyawira Mwangi
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; Kenya Medical Training College, Nairobi, Kenya
| | - Daksha B Patel
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Tunde Peto
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | | | - Solange R Salomão
- Departamento de Oftalmologia e Ciências Visuais, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Bernadetha R Shilio
- Department of Curative Services, Ministry of Health Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, WHO, Geneva, Switzerland
| | - Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Aubrey Webson
- Permanent Mission of Antigua and Barbuda to the United Nation, New York, NY, USA
| | - Sheila K West
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore; Duke-NUS Medical School, Singapore
| | - Richard Wormald
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Mayinuer Yusufu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China; Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | | | - Serge Resnikoff
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Brien Holden Vision Institute, University of New South of Wales, Sydney, Australia
| | | | - Clare E Gilbert
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Allen Foster
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah B Faal
- Department of Ophthalmology, University of Calabar, Calabar, Nigeria; Africa Vision Research Institute, Durban, South Africa
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The Impact of Surgical Volume on Outcomes and Cost in Cleft Repair: A Kids' Inpatient Database Analysis. Ann Plast Surg 2019; 80:S174-S177. [PMID: 29672335 DOI: 10.1097/sap.0000000000001388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Centralization of specialist services, including cleft service delivery, is occurring worldwide with the aim of improving the outcomes. This study examines the relationship between hospital surgical volume in cleft palate repair and outcomes. METHODS A retrospective analysis of the Kids' Inpatient Database was undertaken. Children 3 years or younger undergoing cleft palate repair in 2012 were identified. Hospital volume was categorized by cases per year as low volume (LV; 0-14), intermediate volume (IV; 15-46), or high volume (HV; 47-99); differences in complications, hospital costs, and length of stay (LOS) were determined by hospital volume. RESULTS Data for 2389 children were retrieved: 24.9% (n = 595) were LV, 50.1% (n = 1196) were IV, and 25.0% (n = 596) were HV. High-volume centers were more frequently located in the West (71.9%) compared with LV (19.9%) or IV (24.5%) centers (P < 0.001 for hospital region). Median household income was more commonly highest quartile in HV centers compared with IV or LV centers (32.3% vs 21.7% vs 18.1%, P < 0.001). There was no difference in complications between different volume centers (P = 0.74). Compared with HV centers, there was a significant decrease in mean costs for LV centers ($9682 vs $,378, P < 0.001) but no significant difference in cost for IV centers ($9260 vs $9682, P = 0.103). Both IV and LV centers had a significantly greater LOS when compared with HV centers (1.97 vs 2.10 vs 1.74, P < 0.001). CONCLUSIONS Despite improvement in LOS in HV centers, we did not find a reduction in cost in HV centers. Further research is needed with analysis of outpatient, long-term outcomes to ensure widespread cost-efficiency.
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Mittal R, Peter J, Mani T, David S. Visual outcome and patient satisfaction after cataract surgery: A pragmatic study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ehrlich JR, Frank C, Smiley J, Le HG, Joseph S, Schilling SG, Stagg BC, Stein JD, Ravindran RD, Haripriya A. Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India. Health Qual Life Outcomes 2018; 16:25. [PMID: 29378607 PMCID: PMC5789621 DOI: 10.1186/s12955-018-0855-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/25/2018] [Indexed: 11/14/2022] Open
Abstract
Background For patient undergoing cataract surgery in India, existing patient-reported outcome (PRO) measures are either not culturally relevant, have not been adequately validated, or are too long to be used in a busy clinical setting. We sought to develop and validate a brief and culturally relevant point-of-care PRO measure to address this need. Methods Twelve items from the Indian Visual Functioning Questionnaire (IND-VFQ) were selected based on preliminary data. Patients 18 years and older were prospectively recruited at Aravind Eye Care System in Madurai, India. Clinical and sociodemographic data were collected and the 12-item short-form IND-VFQ (SF-IND-VFQ) was administered pre- and post-operatively to 225 patients; Factor analysis and Rasch modeling was performed to assess its psychometric properties. Results One item that did not fit a unidimensional scale and had poor fit with the Rasch model was eliminated from the questionnaire. The remaining 11 items represented a single construct (no residual correlations> 0.1) and were largely unaffected by differential item functioning. Five items had disordered thresholds resolved by collapsing the response scale from four to three categories. The survey had adequate reliability (0.80) and good construct (infit range, 0.77–1.29; outfit range, 0.56–1.30) and content (item separation index, 5.87 logits) validity. Measurement precision was fair (person separation index, 1.97). There was evidence that items were not optimally targeted to patients’ visual ability (preoperatively, − 1.92 logits; overall, − 3.41 logits), though the survey measured a very large effect (Cohen’s d 1.80). In a subset of patients, the average time to complete the questionnaire was 2 min 6.3 s. Conclusions The SF-IND-VFQ is a valid, reliable, sensitive, and rapidly administered point-of-care PRO measure to assess changes in visual functioning in patients undergoing cataract surgery in India. Electronic supplementary material The online version of this article (10.1186/s12955-018-0855-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joshua R Ehrlich
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
| | - Charlie Frank
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA
| | - Josiah Smiley
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA
| | - Hong-Gam Le
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA
| | - Sanil Joseph
- Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, Tamil Nadu, India
| | - Stephen G Schilling
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.,Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Brian C Stagg
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Joshua D Stein
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Center for Eye Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA
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Affiliation(s)
- Sundaram Natarajan
- Editor, Indian Journal of Ophthalmology, Chairman, Managing Director, Aditya Jyot Eye Hospital Pvt. Ltd., Wadala (W), Mumbai, Maharashtra, India
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