Hannah C McLane1, Aaron L Berkowitz1, Bryan N Patenaude1, Erica D McKenzie1, Emma Wolper1, Sarah Wahlster1, Günther Fink1, Farrah J Mateen2. 1. From the Department of Neurology (H.C.M.), University of Pennsylvania, Philadelphia; Harvard Medical School (A.L.B., S.W., F.J.M.), Boston; Department of Neurology (A.L.B., S.W.), Brigham & Women's Hospital, Boston; Harvard T.H. Chan School of Public Health (B.N.P., G.F.), Boston; Department of Neurology (E.D.M., E.W., S.W., F.J.M.), Massachusetts General Hospital, Boston; School of Medicine (E.D.M.), Queen's University, Kingston, Canada; and Lesley University (E.W.), Cambridge, MA. 2. From the Department of Neurology (H.C.M.), University of Pennsylvania, Philadelphia; Harvard Medical School (A.L.B., S.W., F.J.M.), Boston; Department of Neurology (A.L.B., S.W.), Brigham & Women's Hospital, Boston; Harvard T.H. Chan School of Public Health (B.N.P., G.F.), Boston; Department of Neurology (E.D.M., E.W., S.W., F.J.M.), Massachusetts General Hospital, Boston; School of Medicine (E.D.M.), Queen's University, Kingston, Canada; and Lesley University (E.W.), Cambridge, MA. fmateen@partners.org.
Abstract
OBJECTIVE: To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. METHODS: An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient. RESULTS: Availability of EEG and EMG is correlated with higher World Bank income group (correlation coefficient 0.38, test for trend p = 0.046; 0.376, p = 0.043); CSF, CT, and MRI did not show statistically significant associations with income groups. Patients in public systems wait longer for neurodiagnostic tests, especially MRI, EEG, and urgent CT (p < 0.0001). The mean cost per test, across all tests, was lower in the public vs private sector (US $55.25 vs $214.62, p < 0.001). Each drop in World Bank income group is associated with a 29% decrease in the estimated share of the population who can afford a given test (95% confidence interval -33.4, 25.2; p < 0.001). In most low-income countries surveyed, only the top 10% or 20% of the population was able to afford tests below catastrophic levels. In surveyed lower-middle-income countries, >40% of the population, on average, could not afford neurodiagnostic tests. CONCLUSIONS: Neurodiagnostic tests are least affordable in the lowest income settings. Closing this "diagnostic gap" for countries with the lowest incomes is essential.
OBJECTIVE: To determine the availability, accessibility, and affordability of EEG, EMG, CSF analysis, head CT, and brain MRI for neurologic disorders across countries. METHODS: An online, 60-question survey was distributed to neurology practitioners in 2014 to assess the presence, wait time, and cost of each test in private and public health sectors. Data were stratified by World Bank country income group. Affordability was calculated with reference to the World Health Organization's definition of catastrophic health expenditure as health-related out-of-pocket expenditure of >40% of disposable household income, and assessment of providers' perceptions of affordability to the patient. RESULTS: Availability of EEG and EMG is correlated with higher World Bank income group (correlation coefficient 0.38, test for trend p = 0.046; 0.376, p = 0.043); CSF, CT, and MRI did not show statistically significant associations with income groups. Patients in public systems wait longer for neurodiagnostic tests, especially MRI, EEG, and urgent CT (p < 0.0001). The mean cost per test, across all tests, was lower in the public vs private sector (US $55.25 vs $214.62, p < 0.001). Each drop in World Bank income group is associated with a 29% decrease in the estimated share of the population who can afford a given test (95% confidence interval -33.4, 25.2; p < 0.001). In most low-income countries surveyed, only the top 10% or 20% of the population was able to afford tests below catastrophic levels. In surveyed lower-middle-income countries, >40% of the population, on average, could not afford neurodiagnostic tests. CONCLUSIONS: Neurodiagnostic tests are least affordable in the lowest income settings. Closing this "diagnostic gap" for countries with the lowest incomes is essential.
Authors: Antonio Lora; Robert Kohn; Itzhak Levav; Ryan McBain; Jodi Morris; Shekhar Saxena Journal: Bull World Health Organ Date: 2011-10-31 Impact factor: 9.408
Authors: Alexandra Cameron; Amit Bansal; Tarun Dua; Suzanne R Hill; Solomon L Moshe; Aukje K Mantel-Teeuwisse; Shekhar Saxena Journal: Epilepsia Date: 2012-03-20 Impact factor: 5.864
Authors: Cedric P Yansouni; Emmanuel Bottieau; Pascal Lutumba; Andrea S Winkler; Lut Lynen; Philippe Büscher; Jan Jacobs; Philippe Gillet; Veerle Lejon; Emilie Alirol; Katja Polman; Jürg Utzinger; Michael A Miles; Rosanna W Peeling; Jean-Jacques Muyembe; François Chappuis; Marleen Boelaert Journal: Lancet Infect Dis Date: 2013-04-24 Impact factor: 25.071
Authors: Felicity Dewhurst; Matthew J Dewhurst; William K Gray; Golda Orega; William Howlett; Paul Chaote; Catherine Dotchin; Anna R Longdon; Stella-Maria Paddick; Richard W Walker Journal: Age Ageing Date: 2012-04-19 Impact factor: 10.668
Authors: Ke Xu; David B Evans; Kei Kawabata; Riadh Zeramdini; Jan Klavus; Christopher J L Murray Journal: Lancet Date: 2003-07-12 Impact factor: 79.321
Authors: Jennifer A Williams; Fodé Abass Cisse; Mike Schaekermann; Foksouna Sakadi; Nana Rahamatou Tassiou; Gladia C Hotan; Aissatou Kenda Bah; Abdoul Bachir Djibo Hamani; Andrew Lim; Edward C W Leung; Tadeu A Fantaneanu; Tracey A Milligan; Vidita Khatri; Daniel B Hoch; Manav V Vyas; Alice D Lam; Joseph M Cohen; Andre C Vogel; Edith Law; Farrah J Mateen Journal: Seizure Date: 2019-05-31 Impact factor: 3.184
Authors: Veronica Bruno; Joshua P Klein; Dechen Nidup; Damber K Nirola; Lhab Tshering; Sonam Deki; Sarah J Clark; Kristin A Linn; Russell T Shinohara; Chencho Dorji; Dili Ram Pokhrel; Ugyen Dema; Farrah J Mateen Journal: Ann Glob Health Date: 2017-04-07 Impact factor: 2.462
Authors: Minyoung Jang; Foksouna Sakadi; Nana R Tassiou; Cissé F Abass; Sara J Grundy; Arcer Woga; Bah A Kenda; Condé M Lamine; Balde A Talibé; Hongxiang Qiu; Joseph M Cohen; Marco Carone; Farrah J Mateen Journal: Seizure Date: 2018-07-24 Impact factor: 3.184
Authors: Lucas Battel; Fernanda Cunegatto; Anna Viduani; Helen L Fisher; Brandon A Kohrt; Valeria Mondelli; Johnna R Swartz; Christian Kieling Journal: Neuroimage Date: 2021-02-14 Impact factor: 6.556