1
|
Bharti SK, Gupta I, Akshima, Madaan P, Devi N, Dhir P, Negi S, Sankhyan N, Sahu JK, Bansal D. Societal costs of illness for infantile epileptic spasms syndrome and evolutionary cost prediction in the era of WHO's IGAP. Epilepsy Res 2024; 199:107284. [PMID: 38159425 DOI: 10.1016/j.eplepsyres.2023.107284] [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: 10/19/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND To achieve the goal of improving the quality of life for persons with epilepsy within the framework of the WHO's Intersectoral Global Action Plan (IGAP), our study aimed to assess the societal financial burden linked to infantile epileptic spasms syndrome (IESS), ensuring that children afflicted with IESS receive high-quality healthcare without enduring substantial financial constraints. METHODS Between August 2022 and March 2023, 92 children with IESS (male: female: 2:1), recently diagnosed or previously followed-up, were recruited. We gathered costs for drugs, tests, and medical services, along with legal guardians' monthly income. Total expenditure was determined by multiplying unit costs by the yearly service usage commencing from the onset. Time series analysis was utilised to forecast the financial burden from 2022 to 2032. RESULTS Clinicians' first choice of treatment was ACTH (n = 60, 65·2%), prednisolone (n = 25, 27·2%), and vigabatrin (n = 7, 7·6%) and the median cost of treatment during the initial year was INR 39,010 [USD 479·2]. The median direct medical, direct non-medical, and indirect cost were INR 31,650 [USD 388·4], INR 6581 [USD 80·8], and INR 10,100 [USD 124·07], respectively. Families lost a median of 12 days of work annually. Drug costs and loss of wages were the key factors in the financial burden. The projected and adjusted figures exhibited an incremental growth rate of 2·6% tri-annually. INTERPRETATION This pioneering study in developing countries, the first of its kind, evaluates the societal cost, financial hardship, and trajectory of incremental cost in IESS. The primary drivers of the financial burden were pharmacological treatment and family work adjustments. The government shoulders 62% of the financial burden, and projected a triannual growth of 2·6% from 2022 to 2032. Our results rationalize policymakers' focus on incorporating IESS into social security programs, particularly in developing countries.
Collapse
Affiliation(s)
- Saroj Kundan Bharti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Ishneet Gupta
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Akshima
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Priyanka Madaan
- Department of Pediatric Neurology, Amrita School of Medical Sciences, Faridabad, India; Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nagita Devi
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India
| | - Pooja Dhir
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Negi
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Dipika Bansal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research, Mohali, Punjab, India.
| |
Collapse
|
2
|
Gulati S, Sinha R, Madaan P. Ethical, Social, and Economic Challenges in Managing a Child with Dravet Syndrome in a Developing Country. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1714065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractEpilepsy is a chronic neurological disorder with a significant impact on sociocultural and economic aspects. The management of epilepsy in low-middle income countries (LMICs) is influenced by many factors such as disease burden, poverty, educational status, the reflection of the disease as a social stigma, diverse religious beliefs, and treatment expense. Despite the improvement in educational and social parameters, the stigmatization of the disease is still evident in many LMICs. The associated comorbidities and neurodevelopmental disorders further add to the cost and stigmatization. The pediatric neurologists/epileptologists in LMICs are encountered by distinctive ethical, social, and economic dilemmas during the patient care and management of epilepsy. This article discusses the various ethical dilemmas in a child with Dravet syndrome in a developing country.
Collapse
Affiliation(s)
- Sheffali Gulati
- Division of Child Neurology, Department of Pediatrics, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rahul Sinha
- Division of Child Neurology, Department of Pediatrics, Center of Excellence & Advanced Research on Childhood Neurodevelopmental Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Madaan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
3
|
Jukkarwala A, Baheti NN, Dhakoji A, Salgotra B, Menon G, Gupta A, Prakash S, Rathore C. Establishment of low cost epilepsy surgery centers in resource poor setting. Seizure 2019; 69:245-250. [PMID: 31121549 DOI: 10.1016/j.seizure.2019.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To prospectively assess the feasibility of establishing low cost epilepsy surgery programs in resource poor settings. METHOD We started epilepsy surgery centers in Tier 2 and Tier 3 cities in India in private hospitals. This model is based on the identifying and operating ideal epilepsy surgery candidates on the basis of clinical history, interictal and ictal video-EEG data, and 1.5 T MRI without other investigations and without regular involvement of other specialists. Trained epileptologists formed the fulcrum of this program who identified ideal candidates, offered them counseling, and read video-EEG and MRI. We also spread epilepsy awareness among locals and physicians and established focused epilepsy clinics. The expenses were subsidized for deserving patients and policies were devised to keep video-EEG duration and staff requirement to minimum. Difficult epilepsy surgery cases were referred to established centers. Initial surgeries were performed by invited epilepsy surgeons and subsequently by local neurosurgeons. RESULTS A total of 125 epilepsy surgeries were performed at three centers since 2012. This included 81(64.8%) temporal lobe resections, 26 (20.8%) extratemporal focal resections, and 13 (10.4%) hemispherotomies. Of the 93 patients with more than 1 year of postoperative followup, 86 (92.5%) had Engel class IA outcome. There were minor complications in 5% patients. Average cost of presurgical evaluation and surgery was Rs. 92,707 (USD 1,324). CONCLUSIONS It is possible to establish successful epilepsy surgery programs in resource poor setting with reasonable costs. This low cost model can be replicated in other parts of world to reduce the surgical treatment gap.
Collapse
Affiliation(s)
- Anis Jukkarwala
- Department of Neurology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Neeraj N Baheti
- Department of Neurology, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Amit Dhakoji
- Department of Neurology, Central India Institute of Medical Sciences, Nagpur, Maharashtra, India; Department of Neurosurgery, Sahyadri Super Speciality Hospital, Pune, Maharashtra, India
| | - Bhagwati Salgotra
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
| | - Aditya Gupta
- Department of Neurosurgery, Artemis Hospital, Gurugram, Haryana, India
| | - Sanjay Prakash
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| | - Chaturbhuj Rathore
- Department of Neurosciences, Smt. B. K. Shah Medical Institute and Research Center, Sumandeep Vidyapeeth, Vadodara, Gujarat, India.
| |
Collapse
|
4
|
Hongally C, Sneha V, Archana G. How to make rules and regulations for the states in accordance with the Mental Healthcare Act 2017. Indian J Psychiatry 2019; 61:S827-S831. [PMID: 31040482 PMCID: PMC6482695 DOI: 10.4103/psychiatry.indianjpsychiatry_156_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mental Healthcare Act (MHCA) 2017 was gazetted on April 7, 2017. It repeals the Mental Health Act, 1987, and it can be implemented only after the state rules are formed. The central government has already published three sets of rules. This article was written with an objective to review how to make rules and regulations for the state as per MHCA, 2017. All sections of MHCA 2017 and the mental health rules previously made by different states according to the Mental Health Act 1987 were reviewed. Google and PubMed searches were done to review the implementation of their respective mental health acts by different countries and states in the past. Go through Central/State Mental Health Rules, 2018, framed by the central government. Try to adapt it for the state. A meeting on MHCA 2017 should be conducted, including all stakeholders who will give their suggestions about changes to be made. Frame an initial draft and discuss it with the stakeholders and finalize the draft. Discuss the draft in state mental health authority meetings and submit the draft to the government. The Department of Legislation and Parliamentary Affairs can be consulted. The draft should be sent to the central government's Ministry of Health and Family Welfare for approval. According to MHCA 2017, state rules can be formed in relation to the aspects mentioned under Sections 121 and 123. The state government should make notification of the rules and then implement them.
Collapse
Affiliation(s)
- Chandrashekar Hongally
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - V Sneha
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - G Archana
- Department of Psychiatry, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| |
Collapse
|
5
|
Patel V, Xiao S, Chen H, Hanna F, Jotheeswaran AT, Luo D, Parikh R, Sharma E, Usmani S, Yu Y, Druss BG, Saxena S. The magnitude of and health system responses to the mental health treatment gap in adults in India and China. Lancet 2016; 388:3074-3084. [PMID: 27209149 DOI: 10.1016/s0140-6736(16)00160-4] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This Series paper describes the first systematic effort to review the unmet mental health needs of adults in China and India. The evidence shows that contact coverage for the most common mental and substance use disorders is very low. Effective coverage is even lower, even for severe disorders such as psychotic disorders and epilepsy. There are vast variations across the regions of both countries, with the highest treatment gaps in rural regions because of inequities in the distribution of mental health resources, and variable implementation of mental health policies across states and provinces. Human and financial resources for mental health are grossly inadequate with less than 1% of the national health-care budget allocated to mental health in either country. Although China and India have both shown renewed commitment through national programmes for community-oriented mental health care, progress in achieving coverage is far more substantial in China. Improvement of coverage will need to address both supply-side barriers and demand-side barriers related to stigma and varying explanatory models of mental disorders. Sharing tasks with community-based workers in a collaborative stepped-care framework is an approach that is ripe to be scaled up, in particular through integration within national priority health programmes. India and China need to invest in increasing demand for services through active engagement with the community, to strengthen service user leadership and ensure that the content and delivery of mental health programmes are culturally and contextually appropriate.
Collapse
Affiliation(s)
- Vikram Patel
- London School of Hygiene & Tropical Medicine, London, UK; Centre for the Control of Chronic Conditions, Guragon, India; Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China.
| | - Hanhui Chen
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Fahmy Hanna
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - A T Jotheeswaran
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland
| | - Dan Luo
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Rachana Parikh
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Eesha Sharma
- Department of Psychiatry, King George Medical University, Lucknow, Uttar Pradesh, India
| | | | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, China
| | - Benjamin G Druss
- Mental Health School of Public Health: Health Policy & Management, Emory University, Atlanta, GA, USA
| | - Shekhar Saxena
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| |
Collapse
|
6
|
Amudhan S, Gururaj G, Satishchandra P. Epilepsy in India II: Impact, burden, and need for a multisectoral public health response. Ann Indian Acad Neurol 2015; 18:369-81. [PMID: 26713005 PMCID: PMC4683872 DOI: 10.4103/0972-2327.165483] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Epilepsy is a common neurological disorder whose consequences are influenced socially and culturally, especially in India. This review (second of the two part series) was carried out to understand the social impact and economic burden to develop comprehensive program for control and prevention of epilepsy. Epilepsy is known to have adverse effect on education, employment, marriage, and other essential social opportunities. Economic burden associated with epilepsy is very high with treatment and travel costs emerging as an important contributing factor. A vicious cycle between economic burden and poor disease outcome is clear. There is no significant change in the perception, stigma, and discrimination of epilepsy across the country despite improvement in educational and social parameters over the time. The huge treatment gap and poor quality of life is further worsened by the associated comorbidities and conditions. Thus, a multidisciplinary response is needed to address the burden and impact of epilepsy which calls for an integrated and multipronged approach for epilepsy care, prevention, and rehabilitation. Service delivery, capacity building, integration into the existing program, mobilizing public support, and increasing public awareness will be the hallmarks of such an integrated approach in a public health model.
Collapse
Affiliation(s)
- Senthil Amudhan
- Department of Epidemiology, Centre for Public Health, Bangalore, Karnataka, India
| | - Gopalkrishna Gururaj
- Department of Epidemiology, Centre for Public Health, Bangalore, Karnataka, India
| | - Parthasarathy Satishchandra
- Director/Vice-chancellor and Professor of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
7
|
Radhakrishnan K. Compassion, commitment, and dedication: Epilepsy & behavior on its 15th anniversary. Epilepsy Behav 2014; 40:104. [PMID: 25278317 DOI: 10.1016/j.yebeh.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
|
8
|
The Reliability of an Epilepsy Treatment Clinical Decision Support System. J Med Syst 2014; 38:119. [DOI: 10.1007/s10916-014-0119-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022]
|
9
|
Treatment expenditure pattern of epileptic patients: a study from a tertiary care hospital, kolkata, India. Neurol Res Int 2014; 2014:869572. [PMID: 24707400 PMCID: PMC3953574 DOI: 10.1155/2014/869572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 10/28/2013] [Accepted: 10/29/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction. Neurological diseases are very important causes of prolonged morbidity and disability leading to profound financial loss. Epilepsy is one of the most important neurological disorders. It being a cost intensive disorder poses a significant economic burden to the country. Aims and Objectives. The study was conducted among the persons with epilepsy (PWE) to assess their expenditure pattern for epilepsy treatment and its rural urban difference. Materials and Methods. 315 PWE selected by systematic random sampling and their caregivers were interviewed with the predesigned, pretested semistructured proforma. Subsequently data were compiled and analyzed using SPSS 18.0 software. Results and Conclusion. Majority of the study population were in the age group of 16–30 years. Majority belonged to classes IV and V of Prasad socioeconomic status scale. Average total expenditure per month for treatment of epilepsy was 219 INR, mainly contributed by drugs, travel, investigations, and so forth. Rural population was having higher treatment expenditure for epilepsy specially for travel and food and lodging in order to get epilepsy treatment. Wage loss in the last three months was present in 42.86% study subjects which was both affected by seizure episodes and travel for visits. Better district care would have helped in this situation.
Collapse
|
10
|
|
11
|
Keikelame MJ, Hills RM, Naidu C, de Sá A, Zweigenthal V. General practitioners' perceptions on management of epilepsy in primary care settings in Cape Town, South Africa: an exploratory pilot study. Epilepsy Behav 2012; 25:105-9. [PMID: 22795316 DOI: 10.1016/j.yebeh.2012.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/01/2012] [Accepted: 06/03/2012] [Indexed: 11/28/2022]
Abstract
In a context where there are few neurologists, excellent management of patients with epilepsy at a primary care level is imperative. In South Africa, most uninsured patients suffering from epilepsy and other chronic illnesses are managed by general practitioners in state-provided primary care settings. We conducted a qualitative pilot study to explore perceptions of doctors working in primary care settings in Cape Town regarding the quality of epilepsy management. Our analysis revealed that these clinicians believe that epilepsy is poorly managed. Attributing factors were consistent with those found in literature. Although study findings cannot be generalized, we conclude that lack of attention to factors impacting on management of epilepsy is a serious concern and may lead to violations of health rights. Urgent prioritization, advocacy, collaboration, and empowerment of healthcare professionals, patients, lay carers, and the general public are needed to improve the management and quality of care of PWE.
Collapse
Affiliation(s)
- Mpoe Johannah Keikelame
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, South Africa.
| | | | | | | | | |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW This review discusses recent literature relevant to the diagnosis and treatment of epilepsy in developing countries with particular attention to underlying causes, natural history, and advances made toward optimizing systems of care and bridging the treatment gap. RECENT FINDINGS Prospective data suggest that cerebral malaria-induced brain injury may explain the high prevalence of epilepsy in malaria-endemic regions. Population-based mortality studies support the long proposed hypothesis that seizure-related deaths contribute to excessive premature mortality. WHO guidelines have the potential to improve care, but macrolevel barriers related to pharmaceutical regulation and distribution continue to contribute to the treatment gap. Evidence-based guidelines endorsed by the WHO and American Academy of Neurology regarding the optimal management of comorbid epilepsy and HIV may raise awareness regarding critical drug interactions between antiepileptic drugs and antiretrovirals, but are also problematic as the treatment regimen and diagnostic facilities routinely available in developing countries will prevent most healthcare providers from following the recommendations. SUMMARY New insights into the causes, natural history and best care practices for epilepsy in developing countries are available but without prioritization and action from policy makers, the present treatment gap will likely to persist.
Collapse
|