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, 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 consul