ABSTRACT
Background: Epilepsy is a chronic brain disorder characterized by recurrent seizures and epileptic patients often require prolonged medication and frequent visits to neurology clinics. This often has adverse economic effect on the household’s income and expenditure. Unfortunately, the cost of epilepsy amongst children has not been extensively studied in southeast region of Nigeria.
Aim: The study estimated the direct and indirect costs of epilepsy amongst children, the distribution of these costs across different socio-economic groups, and households’ modes of payment and payment coping mechanisms.
Methods: The study took place at the Neurology clinic of the Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu in southeast Nigeria. Data were collected using interviewer-administered questionnaires administered to 134 caregivers. Different socio-economic groups (SES) were categorized using principal component analysis (PCA) based on household assets. The direct cost was computed based on registration/card fee, consultation fee, drugs cost, laboratory tests costs, and admission fee. The indirect cost was estimated from presumed income loss of the caregivers from the time taking care of the epileptic child. Expenditure was based on monthly spending on out-patient and inpatient services. The catastrophic health expenditures were measured using a cutoff of 40% of monthly non-food expenditure.
Results: The mean household direct expenditure on out-patient carewas 3849.20 Naira/ month, while for in-patient serviceswere 50,328.00 Naira/ admission. Expenditures on laboratory tests (48.7% – 61.3%) and drugs (25.4% – 35.3%) were highest contributor to the costs. The mean annual direct and indirect costs were 25,201.00 Naira and 12,757.00 Naira respectively. Catastrophic health expenditures (CHE) were 34.1% for out-patient care and 58% for in-patient care. The lesser poor experienced the highest level of CHE. All payments were out-of-pocket. The average waiting time at the out-patient department (OPD) was 6.1 hours, whilst average time spent on in-patient care was 7.3 days.
Conclusion: The cost of treatment for childhood epilepsy is high and catastrophic to many households. This may be due to lack of utilization of health financial risk protection mechanisms by the affected households. Policymakers should implement a health reform mechanisms such as fee exemption for epileptic drugs and laboratory tests as well as develop more means of scaling-up utilization of health financial risk protection mechanisms e.g community-based health insurance.
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