title: Health and economic benefits of public financing of epilepsy treatment in India: An agent-based simulation model.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.|Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.
authors.forename: Itamar
authors.identifier: http://orcid.org/0000-0001-8391-6660
authors.initials: I
authors.lastname: Megiddo
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.|Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.|Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A.
authors.forename: Abigail
authors.initials: A
authors.lastname: Colson
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Dan
authors.initials: D
authors.lastname: Chisholm
authors.affiliation: Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
authors.forename: Tarun
authors.initials: T
authors.lastname: Dua
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.|Public Health Foundation of India, New Delhi, India.
authors.forename: Arindam
authors.initials: A
authors.lastname: Nandi
authors.affiliation: Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia, U.S.A.|Department of Management Science, University of Strathclyde, Glasgow, United Kingdom.|Princeton Environmental Institute, Princeton University, Princeton, New Jersey, U.S.A.
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan
mesh_terms: D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000191:economics* / Q000379:methods; D004827:Epilepsy / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005380:Financing, Government / Q000191:economics* / Q000379:methods; D006801:Humans; D007194:India / Q000453:epidemiology; D007342:Insurance Benefits / Q000191:economics* / Q000379:methods; D013597:Systems Analysis; D016896:Treatment Outcome
keywords: Agent-based model; Cost-effectiveness; Epilepsy; India; Universal public finance