Assessment of the Economic Burden of Specific Learning Disability by Estimating the Direct, Indirect, and Intangible Costs: A Low- and Middle-Income Country Perspective.

Introduction: The economic burden of specific learning disability (SLD) in the Indian setting is high, but a few studies have been done in this regard.

Methods: 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.

Results: 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).

Conclusion: 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.