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J Postgrad Med. 2019 Jun 6. doi: 10.4103/jpgm.JPGM_413_18. [Epub ahead of print]

Economic burden of specific learning disability: A prevalence-based cost of illness study of its direct, indirect, and intangible costs.

Author information

Department of Pediatrics, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India.
Department of Clinical Pharmacology, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, India.



The primary objective of the present study was to evaluate the economic burden of specific learning disability (SpLD) by estimating its direct, indirect, and intangible costs. A secondary objective was to assess the impact of variables on the economic burden.

Settings and Design:

Cross-sectional single-arm descriptive study.


Learning disability clinic in a public medical college in Mumbai.

Subjects and Methods:

The study cases (aged ≥8 years) were recruited by non-probability sampling. A structured questionnaire was used to interview the parent/guardian to collect data related to direct and indirect costs. Intangible costs data were collected by documenting the willingness-to-pay value using the contingent valuation technique.

Statistical Analysis Used:

A quantile regression model was used to assess the impact of predictor variables on the costs.


The direct, indirect, and intangible costs due to SpLD were Indian Rupees (INR) 5,936,053, 29,261,220, and 42,295,000, respectively. Indirect costs comprised 83.1% of the total costs. Expenditure on tuitions and remedial education comprised 61.61% and 64.39% of the indirect and direct costs, respectively. The average annual learning disability clinic costs were INR 2,169,888. The average annual total costs per student were INR 90,773. Longer duration of poor school performance was predictive of higher direct, indirect, and total costs; and higher socioeconomic status was predictive of lower intangible costs.


SpLD is a cost-intensive disability (intangible > indirect > direct costs). Tuitions, which are not the therapy for SpLD, are the most costly component of indirect costs. Remedial education is the most costly component of direct costs.


Attention-deficit hyperactivity disorder; cost of illness; dyslexia; specific learning disorders; students


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