Evaluation of direct medical and non-medical cost of epilepsy at a tertiary neurology center in Rwanda

Introduction We evaluated the annual direct medical cost (aDMC) and direct non-medical cost (aDnMC) of epilepsy management at the Ndera tertiary hospital (Kigali, Rwanda). Methods aDMC was retrospectively calculated upon review of medical records of all persons living with epilepsy (PwE), aged >18 years, and seeking for the first time in 2018 specialist neurology care at Ndera. PwE attended the recommended monthly consultation schedule. Structured interviews were used to determine aDnMC in PwE attending consultation in August 2020. Results Mean total aDMC, based on 55 PwEs, was 248,9 US$. Mean aDMC for medical consultations, administration/technical/laboratory investigations combined, hospitalisation and anti-epileptic drugs were 30.7US$, 48.8, 7.6 US$ and 161.7 US$, respectively. Weighted mean biomedical care aDnMC, based on 69 PwE, was 73.0 US$, including round-trip transportation, food, beverage, and accommodation related to the consultation. The Rwandan Community-Based Health Insurance covered medical care for eligible patients with an weighted aDMC of 226.3 US$. Annual Out-of-Pocket (OoP) cost for PwE were 163.3 US$ per year. Over 50% of PwE sought traditional healers’ care with a weighted mean and median cost of 67.6US$ and 21.5 US$, respectively. Mean time spend at the hospital and mean travel time both exceeded 4hours. Conclusion Epilepsy management, measured by DMC, is an important economic burden for PwE and Rwandan health services. OoP DnMC were three times higher than DMC and exclude costs for traditional healers. Indirect costs, including travel and hospital time, were not monetised but equally represented an important burden