The Economic Burden of Epilepsy in Bhutan

Abstract

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 at Jigme Dorji Wangchuk National Referral Hospital from January to August, 2016. Data were collected on clinical features, 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 household without epilepsy). Findings: 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 (SD: 9.0) days of work or school per year on average, and children missed 18.6 (SD: 34.7) days of school. Among adults, 23 (18%) abandoned employment or school because of epilepsy; seven children (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). Conclusion: In Bhutan, despite universal health care services, households of people with epilepsy face a significant economic burden, which impacts household economic well-being. Indirect costs of epilepsy, including negative effects on school achievement and employment, may disrupt economic potential.