The economic burden of epilepsy in Bhutan

Abstract

Summary Objective: To assess the economic impact of epilepsy in Bhutan, a lower-middle-income country with a universal health care system, but with limited access to neurological care. Methods: A cross-sectional survey was conducted of patients with epilepsy receiving care at Jigme Dorji Wangchuk National Referral Hospital from January to August, 2016. Data were collected on clinical features of epilepsy, cost of care, impact of epilepsy on school or work, and household economic status of participants and matched comparisons (a sibling or neighbor from a separate household without epilepsy). Results: A total of 172 individuals were included in the study (130 adults and 42 children). One-third of adults and 20 (48%) children had seizures at least once per month. Mean annual direct out-of-pocket costs for epilepsy care was 6,054 BTN (91 USD), of which transportation formed the greatest portion (53%). Direct costs of epilepsy were an average of 3.2% of annual household income. Adults missed 6.8 ± 9.0 days of work or school per year on average, and children missed 18.6 ± 34.7 days of school. Of adult participants, 23 (18%) abandoned employment or school because of epilepsy; among school-age children, seven (18%) stopped school because of epilepsy. Households with a person with epilepsy had lower monthly per-person income (6,434 BTN) than comparison households without epilepsy (8,892 BTN; p = 0.027). Significance: In this lower-middle-income country, despite universal health care services, households of people with epilepsy face a significant economic burden. Cost of transportation for epilepsy care contributes a major proportion of the direct cost burden. Indirect costs, including negative effects on school achievement and employment, disrupt the economic potential of people with epilepsy in Bhutan. Household economic well-being is impacted by the direct and indirect costs of epilepsy.

External validation and comparison of two prediction models for seizure recurrence after the withdrawal of antiepileptic drugs in adult patients

“…Nevertheless, nearly 60% of PWE experience adverse effects from AEDs that could result in a significant decline in the quality of life . In addition, PWE face a substantial economic burden because of the long‐term use of AEDs . Withdrawal from AEDs is an obvious means to avoid the adverse influences of taking AEDs, but approximately 34% of PWE treated only with medication will have seizure recurrence after the withdrawal of AEDs .…”

Sleep Related Epilepsy and Pharmacotherapy: An Insight

“…Epilepsy is characterized by frequent and unpredictable disruptions of brain functions resulting in “epileptic seizures.” Epilepsy has a great impact on the quality of life through increased incidence of injury and death, unemployment rates, lower monthly incomes, higher household costs and high absenteeism at work and schools (Jennum et al, 2017 ; Trinka et al, 2018 ; Wibecan et al, 2018 ). An epileptic seizure is considered as a transient episode of signs or symptoms, including transitory confusion, staring speech, irrepressible jerking movements, loss of consciousness, psychic symptoms such as fear and anxiety, due to the abnormal synchronous neuronal activity of the brain.…”

Gender and Socioeconomic Disparities in Global Burden of Epilepsy: An Analysis of Time Trends From 1990 to 2017

“…The negative CI indicated that countries with low levels of socioeconomic development had a higher epilepsy burden. Epilepsy has a significant economic impact on health-care needs, premature death, and disruption of work or education for individuals and their families (4,51). A review of studies estimating the cost of epilepsy reported that the direct and indirect cost per person per year ranged from US$ 1,736 to 5,848 and 2,037 to 8,587, respectively (4).…”