Megiddo Itamar, Colson Abigail, Chisholm Dan, Dua Tarun, Nandi Arindam, Laxminarayan Ramanan
Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.
Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.
Epilepsia. 2016 Mar;57(3):464-74. doi: 10.1111/epi.13294. Epub 2016 Jan 14.
An estimated 6-10 million people in India live with active epilepsy, and less than half are treated. We analyze the health and economic benefits of three scenarios of publicly financed national epilepsy programs that provide: (1) first-line antiepilepsy drugs (AEDs), (2) first- and second-line AEDs, and (3) first- and second-line AEDs and surgery.
We model the prevalence and distribution of epilepsy in India using IndiaSim, an agent-based, simulation model of the Indian population. Agents in the model are disease-free or in one of three disease states: untreated with seizures, treated with seizures, and treated without seizures. Outcome measures include the proportion of the population that has epilepsy and is untreated, disability-adjusted life years (DALYs) averted, and cost per DALY averted. Economic benefit measures estimated include out-of-pocket (OOP) expenditure averted and money-metric value of insurance.
All three scenarios represent a cost-effective use of resources and would avert 800,000-1 million DALYs per year in India relative to the current scenario. However, especially in poor regions and populations, scenario 1 (which publicly finances only first-line therapy) does not decrease the OOP expenditure or provide financial risk protection if we include care-seeking costs. The OOP expenditure averted increases from scenarios 1 through 3, and the money-metric value of insurance follows a similar trend between scenarios and typically decreases with wealth. In the first 10 years of scenarios 2 and 3, households avert on average over US$80 million per year in medical expenditure.
Expanding and publicly financing epilepsy treatment in India averts substantial disease burden. A universal public finance policy that covers only first-line AEDs may not provide significant financial risk protection. Covering costs for both first- and second-line therapy and other medical costs alleviates the financial burden from epilepsy and is cost-effective across wealth quintiles and in all Indian states.
据估计，印度有600万至1000万人患有活动性癫痫，接受治疗的人数不到一半。我们分析了三种由公共资金支持的国家癫痫项目方案的健康和经济效益，这些方案提供：（1）一线抗癫痫药物（AEDs），（2）一线和二线AEDs，以及（3）一线和二线AEDs及手术。
我们使用IndiaSim（一种基于主体的印度人口模拟模型）对印度癫痫的患病率和分布进行建模。模型中的主体无疾病或处于三种疾病状态之一：未治疗且有发作、治疗且有发作、治疗且无发作。结果指标包括患有癫痫且未接受治疗的人口比例、避免的残疾调整生命年（DALYs）以及每避免一个DALY的成本。估计的经济效益指标包括避免的自付费用（OOP）支出和保险的货币价值。
相对于当前情况，所有三种方案都代表了资源的成本效益利用，并且每年在印度可避免80万至100万个DALYs。然而，特别是在贫困地区和人群中，如果我们将就医成本包括在内，方案1（仅由公共资金支持一线治疗）不会降低OOP支出或提供财务风险保护。从方案1到方案3，避免的OOP支出增加，保险的货币价值在各方案之间呈现类似趋势，并且通常随财富水平下降。在方案2和方案3的前10年中，家庭平均每年可避免超过8000万美元的医疗支出。
在印度扩大癫痫治疗并由公共资金支持可避免大量疾病负担。仅涵盖一线AEDs的普遍公共财政政策可能无法提供显著的财务风险保护。涵盖一线和二线治疗以及其他医疗成本可减轻癫痫带来的财务负担，并且在所有财富五分位数和印度所有邦中都具有成本效益。
