Economic burden of seizure disorders on medication adherence and treatment outcomes of people with epilepsy in a Tertiary Hospital in Ibadan, Nigeria

Abstract

Introduction: The burden of seizure disorder in relation to adherence and outcome has not then explored in many developing countries.

Objective: The study aimed at estimating the economic burden of seizure disorder on the patient and their caregivers.

Methods: A Structured and pretested self-administered questionnaire was used to obtain information from the participants. Information was also retrieved from patients’ case notes using a structured data form. Participants’ self-report on medication adherence was assessed using Morisky’s Medication Adherence Scale (MMAS-4). Cost of management (direct cost only) of the disorder was based on patients and families perspective. Data were analyzed with SPSS version 23. Relationship between duration of use of AntiEpileptic Drugs (AEDs) and adherence level was tested using Pearson moment product correlation and p <0.05 considered significant.

Results: One third (19, 37.8%) of the patients were diagnosed with mixed seizure. Carbamazepine was the most commonly prescribed medication (60.8%). Only 18 (35.3%) had high adherence to prescribed medication(s) of which 3 (5.9%) had seizure remission for the past one year. Forgetfulness (31; 60.8%) and cost of medication(s) (24, 47.1%) were the most common reason(s) for non-adherence. Medical bill of 34 (66.7%) of the participants were paid by parents and relatives. Average monthly income of employed participants was ₦56,781.2 ($177.4). Average monthly cost of management per patient obtained was ₦11,723.9 ($36.6). The mean cost of AEDs (₦99,061.1±59,569.7) among adherent group was less than and non-adherent group (₦113,546.9±63,301.6). There is a significant negative correlation between years of use of AEDs and medication adherence score (r = - 0.3, p = 0.04).

Conclusion: Economy burden of seizure is huge among the participants. Medical bills of more than two-third of them was borne by caregivers while those employed spent one-fifth of their monthly income on the disorder. Treatment outcome was poor due to high level of non-adherence to medication(s) associated with financial constrain. Measure to improve adherence and ease of financial burden among seizure disorder patients is highly essential.

Keywords: Seizure disorders, Adherence, Cost, AED, Outcome