Panda Prateek K, Ramachandran Aparna, Bhadoria Ajeet S, Sharawat Indar K
Department of Pediatrics, Pediatric Neurology Division, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Department of Neurology, IQRAA International Hospital and Research Centre, Kozhikode, Kerala, India.
Neurol India. 2025 Mar 1;73(2):298-305. doi: 10.4103/ni.ni_805_22. Epub 2025 Apr 3.
The economic burden of specific learning disability (SLD) in the Indian setting is high, but a few studies have been done in this regard.
This cross-sectional questionnaire-based descriptive cost of illness study was conducted in the pediatric neurocognitive clinic at a premier teaching hospital in North India between January and December 2021 to determine the economic burden of SLD by estimating the direct, indirect, and intangible costs related to this illness from the perspectives of afflicted families, health care providers, and society and to assess the impact of demographic and clinical variables on the economic burden. A "person-based" "bottom-up" approach for estimating costs from the perspective of the "afflicted families" was followed. A pre-designed structured questionnaire, while interviewing the parent/guardian of SLD patients, to collect data related to cost of treatment for SLD in their child under three types of expenses was used. The contingent valuation technique was used to document the willingness-to-pay value for estimating intangible cost data.
A total of 162 SLD patients (64% boys, 107 newly diagnosed, and 55 diagnosed in previous years and under regular follow-up) were enrolled. From the perspectives of afflicted families, the direct, indirect, total, and intangible costs were estimated to be INR 2,618,030, 14,525,180, 17,143,210, and 30,658,470, respectively (median 16,878, 89,771, 104,689, and 200,000). The "average annual total costs of SLD" were estimated to be INR 11,213,710 (the average annual cost per student was INR 69,220). Expenditure availed on special educators and tuition teachers constituted 64.5% and 54.3% of the direct and indirect costs, respectively. Both socio-economic status (P = 0.001, 0.002, 0.006) and duration of poor scholastic performance (P = 0.01, 0.02, and 0.04) were significant predictors of "direct costs", "indirect costs", and "total costs" for SLD. But only socio-economic status was a significant predictor of "intangible costs" (P = 0.009) and co-morbid psychiatric illness was a significant predictor only for "direct costs" (P = 0.03).
The economic burden of SLD is huge, and most cases are diagnosed/referred late. There is an urgent need for Government-initiated SLD-specific programs to avail affordable remedial education for SLD-afflicted children in schools and create more skilled personnel in schools and hospitals, who can screen these children early and counsel parents to avoid wasteful expenditure.
在印度，特定学习障碍（SLD）的经济负担很高，但在这方面开展的研究较少。
2021年1月至12月，在印度北部一家一流教学医院的儿科神经认知诊所开展了这项基于问卷调查的横断面疾病成本描述性研究，以通过从患病家庭、医疗服务提供者和社会的角度估算与该疾病相关的直接、间接和无形成本来确定SLD的经济负担，并评估人口统计学和临床变量对经济负担的影响。采用了一种从“患病家庭”角度估算成本的“基于个体”的“自下而上”方法。在对SLD患者的家长/监护人进行访谈时，使用预先设计的结构化问卷，收集与孩子SLD治疗费用相关的三类费用数据。采用条件估值技术记录用于估算无形成本数据的支付意愿值。
共纳入162例SLD患者（64%为男孩，107例为新诊断患者，55例为既往诊断且处于定期随访中）。从患病家庭的角度来看，直接成本、间接成本、总成本和无形成本估计分别为2618030印度卢比、14525180印度卢比、17143210印度卢比和30658470印度卢比（中位数分别为16878、89771、104689和200000）。“SLD的年均总成本”估计为11213710印度卢比（每名学生年均成本为69220印度卢比）。在特殊教育教师和辅导教师方面的支出分别占直接成本和间接成本的64.5%和54.3%。社会经济地位（P = 0.001、0.002、0.006）和学业成绩不佳的持续时间（P = 0.01、0.02和0.04）均是SLD“直接成本”“间接成本”和“总成本”的显著预测因素。但只有社会经济地位是“无形成本”的显著预测因素（P = 0.009），而共病精神疾病仅是“直接成本”的显著预测因素（P = 0.03）。
SLD的经济负担巨大，且大多数病例诊断/转诊较晚。迫切需要政府发起针对SLD的特定项目，为学校中受SLD影响的儿童提供负担得起的补救教育，并在学校和医院培养更多专业人员，以便能够早期筛查这些儿童并为家长提供咨询，避免浪费性支出。
