The Health and Economic Benefits of Public Financing of Epilepsy Treatment in India

Authors: Itamar Megiddo, Abigail Colson, Dan Chisholm, Tarun Dua, Ramanan Laxminarayan, Arindam Nandi

Objective: No national epilepsy program currently exists in India, where an estimated 6–10 million live with active epilepsy and only 47% of them are treated. The literature on epilepsy interventions in India and in South Asia focuses on cost-effectiveness analysis of 1st-line anti-epilepsy drugs (AEDs) and does not consider the economic effects of policies to increase treatment. We analyze the health and economic benefits (including from the health consumers’ perspectives) of increasing effective coverage to 80% and publicly financing 1) 1st-line AEDs, 2) 1st- and 2nd-line AEDs, and 3) and 1st- and 2nd-line AEDs and surgery.
Methods: We use IndiaSim, an agent-based model, and incorporate an epilepsy disease model. Agents are in one of four states: disease free, untreated with seizures, treated with seizures, and treated without seizures. We analyze the benefits from policy intervention over a 35-year period, until the model population reaches a new equilibrium state. To evaluate the health benefits and cost-effectiveness we calculate the percent of the population that is epileptic and untreated, the disability-adjusted life years (DALYs) averted, direct medical costs paid by the government and dollars per DALY averted. To analyze the economic benefits we estimate the out-of-pocket (OOP) expenditure averted, and money-metric value of insurance.
Results: Over 35 years the sequential incremental (to the baseline) DALYs averted and dollars per DALY averted are: 788 (774–802) DALYs per 100,000 persons and $9.22 ($9.05–$9.39) per DALY averted in intervention 1; 107 (94–120) DALYs per 100,000 and $982 ($568–$1,397) per DALY in intervention 2; and 66 (53–80) per 100,000 and $2,221 (-$4,530–8,973) per DALY in intervention 3. The population averts $19,627 ($18,315–$20,940) OOP expenditure per 100,000 in intervention 1, an additional $88,325 ($86,619–$90,031) per 100,000 in intervention 2, and $31,394 ($29,399–$33,390) in intervention 3. The money-metric value of insurance follows a similar trend between interventions and typically decreases with wealth. Poorer states that avert a high OOP have the highest money-metric value of insurance. Protection is above $25,000 per 100,000 persons in Bihar, West Bengal, Jammu and Kashmir, and the eastern states of Minpur and Tripura.
Significance: Expanding and publicly financing epilepsy treatment in India averts substantial disease and financial burden across wealth quintiles and in all states in India. All three interventions considered are cost-effective in India.

Megiddo, I, A. Colson, D. Chisholm, T. Dua and R. Laxminarayan. 2015. The health and economic benefit of public financing of epilepsy treatment in India. Disease Control Priorities Working Paper Series. No. 14.