Direct cost of headache treatment in Benin, a West African country, in 2023

Headache is a public health problem in Africa and is a significant cause of neurological consultations, imposing a heavy burden. Data on its actual economic burden are scarce in Africa. This study aims to evaluate the direct cost of headache management in 2023 and to identify factors associated with the high direct cost of headache management.

This cohort study with descriptive and analytical aims was conducted from June 15 to October 15, 2023, in the neurology unit of the teaching hospital of Borgou in Parakou, on 91 subjects with headaches, including migraine, tension type headache, trigeminal neuralgia, cluster headache, paroxysmal hemicrania and secondary headache. Any patient who had experienced headaches in the past 12 months, who was aged at least 18 years and who provided informed consent was included. The direct cost of headache management was defined as the sum of costs by consumption level category (consultation, diagnostic tests, treatments, transport, hospitalization costs, other nonmedical costs) and the monetary value of the main companion. This cost was expressed in Benin's local currency (West African francs XOF), with a corresponding amount in euros. The direct cost of headache care was considered high when the mean monthly direct cost was more than 10% of the guaranteed minimum wage in Benin. Consumption level data were collected through an individual interview, supplemented by a review of medical records, notebooks, and receipts for headache management. Data entry was carried out via the KoboCollect application. Data analysis was performed using EpiInfo 7.2 software.

A total of 91 participants were included, with 51 women (56.04%). The mean age was 38.91 ± 14.52 years. The monthly direct cost estimated one month after inclusion was high, calculated at XOF1,599,400 (€2,438.26), with an average of XOF17,575.82 ± 10,290.68 (€26.79 ± 15.69), representing 33.80% of the minimum wage in Benin. The global annual direct cost of headaches was XOF15,537,875 (€23,687.23) with a higher cost for tension type headaches at XOF6,077,530 (€9,265.09), whereas that of migraine was calculated at XOF4,603,970 (€7,018.67). The factors associated with high costs of headache management were a history of anxiety (p = 0.02), the presence of comorbidities (p = 0.005), the frequency of attacks (p = 0.048), and consumption related to psychiatric consultation (p = 0.02).

The direct cost of managing headaches is high, with multiple associated factors. Strategies aimed at reducing this cost are urgently needed to optimize management and influence national public health policy for headache patients in Benin.