Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda
Dirk E Teuwen,1,2 Fidele Sebera,1,3,4 Alphonsine Murekeyiteto,5 Ieme Garrez,1,2 Eduardo Sanchez-Iriso,6 Josiane Umwiringirwa,3 Georgette Umuhoza,3 Paul AJM Boon,1,2 Peter Dedeken1,2,7 1Department of Neurology, Ghent University Hospital, Ghent, Belgium; 2 4Brain, Ghent University Hospital, Ghent, Bel...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Dove Medical Press
2023-01-01
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| Series: | ClinicoEconomics and Outcomes Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/epilepsy-related-direct-medical-and-direct-non-medical-cost-in-adult-p-peer-reviewed-fulltext-article-CEOR |
| _version_ | 1797954432559742976 |
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| author | Teuwen DE Sebera F Murekeyiteto A Garrez I Sanchez-Iriso E Umwiringirwa J Umuhoza G Boon PAJM Dedeken P |
| author_facet | Teuwen DE Sebera F Murekeyiteto A Garrez I Sanchez-Iriso E Umwiringirwa J Umuhoza G Boon PAJM Dedeken P |
| author_sort | Teuwen DE |
| collection | DOAJ |
| description | Dirk E Teuwen,1,2 Fidele Sebera,1,3,4 Alphonsine Murekeyiteto,5 Ieme Garrez,1,2 Eduardo Sanchez-Iriso,6 Josiane Umwiringirwa,3 Georgette Umuhoza,3 Paul AJM Boon,1,2 Peter Dedeken1,2,7 1Department of Neurology, Ghent University Hospital, Ghent, Belgium; 2 4Brain, Ghent University Hospital, Ghent, Belgium; 3Neurology Department, CARAES Neuro-Psychiatric Hospital, Kigali, Rwanda; 4Neurology Department, Centre Hospitalier Universitaire (CHU-K), Kigali, Rwanda; 5Pharmacy Department, CARAES Neuro-Psychiatric Hospital, Kigali, Rwanda; 6Department of Economics, Universidad Pública de Navarra, Pamplona-Iruña, Spain; 7Department of Neurology, Heilig Hart Ziekenhuis, Lier, BelgiumCorrespondence: Dirk E Teuwen, Email dirk.teuwen@uzgent.beObjective: Up to one in four patients living with epilepsy (PwE) mentions financial constraints as a reason for loss to follow-up at the Ndera tertiary neuropsychiatry hospital. Therefore, we evaluated the annual direct medical cost (DMC) and direct non-medical cost (DnMC) of epilepsy and calculated costs assuming different follow-up frequency.Materials and Methods: DMC data were obtained from a descriptive retrospective study of medical records, pharmacy dispensation and hospital logs of PwE, following their initial consultation in 2018 and who adhered to the normal clinical practice of monthly consultations for one year. DnMC data were collected through structured interviews of PwE in a cross-sectional cohort in August 2020. DnMC included biomedical care costs (eg, transportation, hospitality) and non-biomedical costs (traditional healer visits). We report weighted means for total costs, health insurance costs, and out-of-pocket costs (OoP).Results: Mean annual total cost was 389.4 US$, of which 226.2 US$ was covered by the Rwandan Health Insurance co-payment for DMC and 163.2 US$ was OoP paid by patients. Mean weighted annual DMC (n = 55) was 248.9 US$. Mean weighted annual DMC for medical consultations and antiseizure medication accounted for 30.7 US$ and 161.7 US$, respectively. Based on structured interviews (n = 69), mean weighted annual DnMC for biomedical care was 73.0 US$. Mean DnMC for traditional healer care was 67.6 US$. Weighted annual total OoP was 163.2 US$ or 20% of the GDP per capita. OoP consisted of 14% DMC co-payment, 45% biomedical DnMC, and 41% traditional healer DnMC.Conclusion: Epilepsy-related costs at a tertiary center are an important economic burden for PwE and Rwandan Health Insurance. Biomedical and traditional healer DnMC constitute 86% of total OoP. Future prospective studies should evaluate outcomes and costs of reduced visit frequency, indirect costs, and costs of comorbidities.Keywords: cost-of-illness, epilepsy, tertiary neurology center, out-of-pocket cost, Rwanda |
| first_indexed | 2024-04-10T23:17:22Z |
| format | Article |
| id | doaj.art-2e27da8c91ee40bfb62731daabbd2e40 |
| institution | Directory Open Access Journal |
| issn | 1178-6981 |
| language | English |
| last_indexed | 2024-04-10T23:17:22Z |
| publishDate | 2023-01-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | ClinicoEconomics and Outcomes Research |
| spelling | doaj.art-2e27da8c91ee40bfb62731daabbd2e402023-01-12T18:03:06ZengDove Medical PressClinicoEconomics and Outcomes Research1178-69812023-01-01Volume 15152780928Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in RwandaTeuwen DESebera FMurekeyiteto AGarrez ISanchez-Iriso EUmwiringirwa JUmuhoza GBoon PAJMDedeken PDirk E Teuwen,1,2 Fidele Sebera,1,3,4 Alphonsine Murekeyiteto,5 Ieme Garrez,1,2 Eduardo Sanchez-Iriso,6 Josiane Umwiringirwa,3 Georgette Umuhoza,3 Paul AJM Boon,1,2 Peter Dedeken1,2,7 1Department of Neurology, Ghent University Hospital, Ghent, Belgium; 2 4Brain, Ghent University Hospital, Ghent, Belgium; 3Neurology Department, CARAES Neuro-Psychiatric Hospital, Kigali, Rwanda; 4Neurology Department, Centre Hospitalier Universitaire (CHU-K), Kigali, Rwanda; 5Pharmacy Department, CARAES Neuro-Psychiatric Hospital, Kigali, Rwanda; 6Department of Economics, Universidad Pública de Navarra, Pamplona-Iruña, Spain; 7Department of Neurology, Heilig Hart Ziekenhuis, Lier, BelgiumCorrespondence: Dirk E Teuwen, Email dirk.teuwen@uzgent.beObjective: Up to one in four patients living with epilepsy (PwE) mentions financial constraints as a reason for loss to follow-up at the Ndera tertiary neuropsychiatry hospital. Therefore, we evaluated the annual direct medical cost (DMC) and direct non-medical cost (DnMC) of epilepsy and calculated costs assuming different follow-up frequency.Materials and Methods: DMC data were obtained from a descriptive retrospective study of medical records, pharmacy dispensation and hospital logs of PwE, following their initial consultation in 2018 and who adhered to the normal clinical practice of monthly consultations for one year. DnMC data were collected through structured interviews of PwE in a cross-sectional cohort in August 2020. DnMC included biomedical care costs (eg, transportation, hospitality) and non-biomedical costs (traditional healer visits). We report weighted means for total costs, health insurance costs, and out-of-pocket costs (OoP).Results: Mean annual total cost was 389.4 US$, of which 226.2 US$ was covered by the Rwandan Health Insurance co-payment for DMC and 163.2 US$ was OoP paid by patients. Mean weighted annual DMC (n = 55) was 248.9 US$. Mean weighted annual DMC for medical consultations and antiseizure medication accounted for 30.7 US$ and 161.7 US$, respectively. Based on structured interviews (n = 69), mean weighted annual DnMC for biomedical care was 73.0 US$. Mean DnMC for traditional healer care was 67.6 US$. Weighted annual total OoP was 163.2 US$ or 20% of the GDP per capita. OoP consisted of 14% DMC co-payment, 45% biomedical DnMC, and 41% traditional healer DnMC.Conclusion: Epilepsy-related costs at a tertiary center are an important economic burden for PwE and Rwandan Health Insurance. Biomedical and traditional healer DnMC constitute 86% of total OoP. Future prospective studies should evaluate outcomes and costs of reduced visit frequency, indirect costs, and costs of comorbidities.Keywords: cost-of-illness, epilepsy, tertiary neurology center, out-of-pocket cost, Rwandahttps://www.dovepress.com/epilepsy-related-direct-medical-and-direct-non-medical-cost-in-adult-p-peer-reviewed-fulltext-article-CEORcost-of-illnessepilepsytertiary neurology centerout-of-pocket costrwanda |
| spellingShingle | Teuwen DE Sebera F Murekeyiteto A Garrez I Sanchez-Iriso E Umwiringirwa J Umuhoza G Boon PAJM Dedeken P Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda ClinicoEconomics and Outcomes Research cost-of-illness epilepsy tertiary neurology center out-of-pocket cost rwanda |
| title | Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda |
| title_full | Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda |
| title_fullStr | Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda |
| title_full_unstemmed | Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda |
| title_short | Epilepsy-Related Direct Medical and Direct Non-Medical Cost in Adult Patients Living with Epilepsy at a Tertiary Neurology Center in Rwanda |
| title_sort | epilepsy related direct medical and direct non medical cost in adult patients living with epilepsy at a tertiary neurology center in rwanda |
| topic | cost-of-illness epilepsy tertiary neurology center out-of-pocket cost rwanda |
| url | https://www.dovepress.com/epilepsy-related-direct-medical-and-direct-non-medical-cost-in-adult-p-peer-reviewed-fulltext-article-CEOR |
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