THE ECONOMIC COST OF TREATMENT OF CHILDHOOD EPILEPSY IN UNIVERSITY OF NIGERIA TEACHING HOSPITAL,ENUGU, SOUTHEAST, NIGERIA

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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.

TABLE OF CONTENTS

TITLE PAGE
TABLE OF CONTENTS
LIST OF TABLES
ABSTRACT

CHAPTER ONE: INTRODUCTION

CHAPTER TWO: LITERATURE REVIEW

CHAPTER THREE: RESEARCH METHODOLOGY

CHAPTER FOUR: RESULTS

CHAPTER FIVE: DISCUSSION
LIMITATION OF STUDY
CONCLUSION AND RECOMMENDATIONS
REFERENCES
APPENDIX


CHAPTER ONE
Introduction:
Epilepsy is a chronic brain disorder characterized by recurrent seizures resulting from excessive discharge of cerebral neurons1 and associated with a variety of clinical manifestations1,2. It is a common neurological disorder in childhood and affects infants and children more than any other age group3. The prevalence rates of childhood epilepsy reported from different countries have shown a wide variation with most clustering around 4 – 6 per 1,000 children under the age of 16 years in developed countries4,5.  In Nigeria, a prevalence of 3.1 per 1,000 children was reported by Dada in his study 6.

Epilepsy can be due to many etiologic factors and can manifest in different forms. In an effort to improve the understanding and clarity about epilepsy, an international committee convened by the International League Against Epilepsy (ILAE), classified epilepsy into generalized and partial epileptic seizures as well as epileptic syndromes7. In order to achieve control and prevent permanent disability, epileptic patients should adhere to treatment, avoid trigger factors, and be regular with clinic visits.
To be able to reduce the incidence of epilepsy means regulation of these etiologic factors through implements of programmes this will come at its own cost. To make informed choices concerning which health problems to address and what interventions to use to alleviate them, we need to know the economic burden imposed by the various health problems.
Therefore Cost of Illness (COI) provides a monetary estimate for the economic burden of diseases. The Cost of Illness (COI) which is defined as the value of the resources that is are expended or foregone as a result of a health problem. The COI includes health sector costs, the value of lost productivity by the patient (indirect cost), and the cost of pain and suffering (intangible costs).   Therefore, benefits of such activities can be estimated in part, by evaluating both the direct cost (drug, laboratory investigations, and hospital services, transportation) and indirect cost (loss in income and productivity due to illness, pain and suffering) avoided if epileptic cases are prevented. With this knowledge we are able to assess the economic impacts of various health problems. And when compared with what was spent or intended to be spent on the interventions that decrease or eliminate the problem, the policy makers will be able to answer the question “is the intervention worth it?”

 Although there are studies on the global cost-of-illnesses, but there are limited studies on the specific cost of childhood epilepsy and its impact on household expenditure in Nigeria. This study estimated both direct and indirect costs of treating epilepsy amongst children from 1 year to 18 years and its economic burden distribution across different socioeconomic groups, their modes of paying for healthcare services and payment coping mechanism......

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