Title: Considering economic reality in calculating the financial burden of epilepsy in China
Abstract: EpilepsiaVolume 52, Issue 2 p. 416-418 Free Access Considering economic reality in calculating the financial burden of epilepsy in China Liang Li, Liang Li [email protected] Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this authorJinmei Li, Jinmei Li Department of Neurology, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this authorXintong Wu, Xintong Wu Epilepsy Center, Department of Neurology, University Hospital of Erlangen-Nuernberg, Erlangen, GermanySearch for more papers by this authorYunke Zhu, Yunke Zhu Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, ChinaSearch for more papers by this authorDing Lei, Ding Lei [email protected] Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this author Liang Li, Liang Li [email protected] Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this authorJinmei Li, Jinmei Li Department of Neurology, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this authorXintong Wu, Xintong Wu Epilepsy Center, Department of Neurology, University Hospital of Erlangen-Nuernberg, Erlangen, GermanySearch for more papers by this authorYunke Zhu, Yunke Zhu Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, ChinaSearch for more papers by this authorDing Lei, Ding Lei [email protected] Department of Neurosurgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, ChinaSearch for more papers by this author First published: 11 February 2011 https://doi.org/10.1111/j.1528-1167.2010.02913.xCitations: 3AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Epilepsy is the most serious common neurologic disorder, affecting people of all ages and socioeconomic classes worldwide. It imposes a considerable burden on the society and on families. Developing countries carry 90% of the financial burden of epilepsy, as 85% of the world's 50 million people with epilepsy live in developing countries (de Boer, 2002). However, the economic burden caused by epilepsy has not been adequately examined in these countries. In those studies that do exist, cost of illness is traditionally estimated under direct costs (cost of medical treatment, other nonmedical expenditures such as travel to hospital, and so on), indirect costs (due to lost productivity), and intangible costs (related to the emotional and social impact of illness on the economy). We can conclude from such studies that the burden on the families of epilepsy patients is heavy, especially since these developing countries rarely have a well-developed insurance system or social security program that covers epilepsy-related costs. These studies, however, neglect important economic concepts, leading to a significant underestimation of the burden. Indeed, the burden may be even more intractable than the epilepsy itself. Hong et al. (2009) first reported the economic burden of epilepsy in China. Direct medical care costs were estimated at RMB 2,529 (USD 372) per year per patient, of which antiepileptic drugs constituted RMB 1,651 (USD 243) and nonmedical direct costs averaged approximately RMB 756 (USD 111). Costs due to loss of productivity averaged approximately RMB 1,968 (USD 289) per patient per year. Taken together, the overall mean annual cost for epilepsy per patient was approximately RMB 5,253 (USD 773), which is more than half of the mean annual income in China. To estimate surgery costs, we selected 50 samples at random among the 110 patients who had accepted surgery for epilepsy in the Department of Neurosurgery in West China Hospital in 2009. The overall cost for these 50 patients was RMB 2,412,755 (USD 354,244), and the average cost was approximately RMB 48,255 (USD 7,085)—about four times the mean annual income in this country. However, these calculations do not sufficiently describe the burden. In his book Principles of Economics,Mankiw (2004) defined "opportunity cost" as "whatever must be given up to obtain some item." In the case of expenditures for epilepsy surgery in our study, RMB 48,255 (USD 7,085) would be adequate to build a plain house in some countryside areas in China. It could also be used to cover the cost of a child's college education or to cover therapy for another illness if another family member had other health problems. Therefore, the "opportunity cost" may be equal to a house, college tuition, or better health conditions for other family members. For the small percentage of patients who successfully complete medication withdrawal and are free of seizures after surgery, the "opportunity cost" may be neglected by the family. However, for the patients who experience an imperfect surgery (e.g., with continuing seizures and/or undesired complications), the opportunity cost cannot be neglected. Furthermore, for most families, 48,000 or more RMB is likely to exceed their entire savings. To obtain the needed surgery and care, they need to borrow money; some patients from the rural areas may even have to sell their cattle to pay for the surgery. To evaluate the economic burden of the disease on these patients, or calculate the cost-effectiveness of a treatment, the opportunity cost should not be neglected. There are approximately 9 million people with epilepsy in China, 6 million with active epilepsy. There are 0.4 million new cases each year. If a medically intractable rate of 30% is assumed, then 1.8 million of the 6 million people with active epilepsy are potential surgical candidates, with an additional 120,000 cases every year. The recent epidemiologic survey of epilepsy (carried out in cooperation with the International League Against Epilepsy/International Bureau for Epilepsy/World Health Organization) has shown that >60% patients with active epilepsy did not receive appropriate treatment in China (Wang et al., 2003). China has 32 provinces, but each province has few hospitals specialized for the treatment of epilepsy. For example, Sichuan province has a population of >80 million, but there are no more than three hospitals offering proficient epilepsy surgery. The economic concept of "oligopoly" (Mankiw, 2004)—a market structure in which only a few sellers offer similar or identical products—may be a suitable description for this situation. This situation not only fails to meet the growing demand of the epilepsy patients, but also can increase the cost to patients indirectly, mainly because most of the patients who live in other cities or provinces have to pay extra for travel and hotel expenditures. Also the oligopoly acts like a price setter (not as a price "taker" in the beneficial competitive market), which will increase the price. Accordingly, the heavy burden for the patients is not only a medical problem, but also a socioeconomic problem, which is difficult to address in a developing country. Zhang (2010) reported that in China, a brain tumor surgery costs US $5,500 in total, of which the surgery itself costs $580, and drugs and medical consumables cost $3,720. In our study, the total cost of epilepsy surgery was similar. We know that the demand for epilepsy medications and surgery materials is inelastic. The financial burden resulting from this inelasticity has never been appropriately evaluated in considering the costs of disease. By introducing some economic concepts, we can see that the patients' burden has generally been underestimated (does not take the "opportunity cost" into consideration) and appears to be intractable (because of the inelasticity and oligopoly associated with supply and demand in developing countries such as China). Only if evaluation of burden includes these concepts can we begin to do something to mitigate the economic burden of patients. Disclosure We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. We declare that we have no conflicts of interest. References de Boer HM. (2002) "Out of the shadows": a global campaign against epilepsy. Epilepsia 43(suppl 6): 7– 8. Wiley Online LibraryPubMedWeb of Science®Google Scholar Hong Z, Qu B, Wu XT, Yang T-H, Zhang Q, Zhou D. (2009) Economic burden of epilepsy in a developing country: a retrospective cost analysis in China. Epilepsia 50: 2192– 2198. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Mankiw G (2004) Principles of economics, 3rd ed. South-Western College Pub, Cincinnati, OH. Web of Science®Google Scholar Wang WZ, Wu JZ, Wang DS, Dai XY, Yang B, Wang TP, Yuan CL, Scott RA, Prilipko LL, de Boer HM, Sander JW. (2003) The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study. Neurology 60: 1544– 1545. CrossrefCASPubMedWeb of Science®Google Scholar Zhang H. (2010) China's irrational medical pricing scheme. Lancet 375: 726. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume52, Issue2February 2011Pages 416-418 ReferencesRelatedInformation
Publication Year: 2011
Publication Date: 2011-02-01
Language: en
Type: article
Indexed In: ['crossref', 'pubmed']
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Cited By Count: 5
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