Skip to main content

Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study



Pakistan is one of the last few countries in which poliomyelitis is endemic. Evidence indicates that out-of-pocket expenditures are a barrier to polio rehabilitation treatment, yet there are no reported figures related to the financial burden of this disease on patients in a recently polio-endemic country.


This study investigated direct costs attributed to rehabilitation treatment of poliomyelitis among Pakistani patients and reported its duration along with the socioeconomic status of poliomyelitis survivors.


The cost of poliomyelitis rehabilitation in Pakistan is high; it has an economic effect on the lives of patients and their families. Despite good education, polio survivors in Pakistan appear to have low socioeconomic status, lower chances of employment and marriage, as well as fewer children. Further research is recommended to explore the burden of disease on society, i.e., indirect costs and suffering.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8


  1. Nielsen NM, Kay L, Wanscher B, Ibsen R, Kjellberg J, Jennum P. Long-term socio-economic consequences and health care costs of poliomyelitis: a historical cohort study involving 3606 polio patients. J Neurol. 2016;263:1120–8.

    Article  Google Scholar 

  2. Centers for Disease Control and Prevention; Hamborsky J, Kroger A, Wolfe S, editors. Epidemiology and prevention of vaccine-preventable diseases. 13th ed. Washington, DC: Public Health Foundation; 2015.

  3. Global Polio Eradication Initiative. Polio now. 2017. Accessed 21 Nov 2017.

  4. Nathanson N, Kew OM. From emergence to eradication: the epidemiology of poliomyelitis deconstructed. Am J Epidemiol. 2010;172:1213–29.

    Article  Google Scholar 

  5. World Health Organization (WHO). Media centre. Poliomyelitis. 2017. Accessed 2 Dec 2017.

  6. Horstmann DM. The poliomyelitis story: a scientific hegira. Yale J Biol Med. 1985;58:79–90.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Shaikh MA, Kamal A, Naqvi I. University Students perspective on polio vaccination: ruse or realistic need for Pakistani children? J Pak Med Assoc. 2014;64:694–6.

    PubMed  Google Scholar 

  8. Silver JK, Wilson DJ. Polio voices: an oral history from the American polio epidemics and worldwide eradication efforts. Westport: Greenwood Publishing Group; 2007.

    Google Scholar 

  9. Thompson KM, Duintjer Tebbens RJ. Retrospective cost-effectiveness analyses for polio vaccination in the United States. Risk Analysis. 2006;26(6):1423–40.

    Article  Google Scholar 

  10. Duintjer Tebbens RJ, Pallansch MA, Cochi SL, Wassilak SG, Linkins J, Sutter RW, et al. Economic analysis of the global polio eradication initiative. Vaccine. 2010;29:334–43.

    Article  Google Scholar 

  11. Musgrove P. Health economics in development. Washinton, DC: The World Bank; 2004. Acccessed 13 Dec 2017.

  12. Farbu E, Gilhus NE. Education, occupation, and perception of health amongst previous polio patients compared to their siblings. Eur J Neurol. 2002;9:233–41.

    CAS  Article  Google Scholar 

  13. Farbu E, Rekand T, Aarli JA, Gilhus NE. Polio survivors—well educated and hard working. J Neurol. 2001;248:500–5.

    CAS  Article  Google Scholar 

  14. Abbas A, Yazdani N. Polio dilemma: a wake-up call for Pakistan. Med Sci. 2014;13:88–9.

    Google Scholar 

  15. Donaldson L, Alwan A, Frieden T, Goldstein S, Pate M. Every last hiding place. 15th report of the Independent Monitoring Board. Global Polio Eradication Initiative. 2017. Accessed 23 Dec 2017.

  16. Naqvi AA, Naqvi SB, Zehra F, Ahmad R, Ahmad N. The cost of poliomyelitis: lack of cost-of-illness studies on poliomyelitis rehabilitation in Pakistan. Arch Pharma Pract. 2016;7:182–4.

    Article  Google Scholar 

  17. End Polio Pakistan. Polio cases district wise. 2016. Accessed 24 Dec 2017.

  18. XE. Currency converter: USD to PKR. 2017. Accessed 24 Dec 2017.

  19. US Department of Labor. Consumer price index inflation calculator. 2017. Accessed 23 Dec 2017.

  20. Weiss MT. Physical therapy examination and treatment of the polio survivor. Learning about and from post-poliomyelitis: a seminar for physical and occupational therapists and physical and occupational therapists assitants. Eighth International Post-Polio and Independent Living Conference; 8–10 Jun 2000; Saint Louis.

  21. Sample size calculator. Raosoft. Accessed 20 Dec 2017.

  22. Pakistan Bureau of Statistics (PBS). Statistical yearbook 2014. 19.12: Disabled population by sex, nature of disability, urban and rural areas and province. Accessed 4 Mar 2018.

  23. Gera N. Pakistan’s healthcare under structural adjustment. Lahore J Econ. 2003;8:65–81.

    Google Scholar 

  24. Akram M, Khan FJ. Health care services and Government spending in Pakistan. PIDE Working Papers. Pakistan Institute of Development Economics. 2007:32. Accessed 2 Jan 20182.

  25. De Vellis RF. Scale development: theory and applications. 26th ed. Thousand Oaks: Sage; 1991.

    Google Scholar 

  26. Cohen JS. Statistical power analysis for the behavioral sciences. 2nd ed. Hillside: Lawrence Erlbaum Associates Inc.; 1988.

    Google Scholar 

  27. Fisher RA. On the interpretation of χ2 from contingency tables, and the calculation of P. J Royal Stat Soc. 1922;85:87–94.

    Article  Google Scholar 

  28. Fisher RA. Statistical methods for research workers. Edinburgh: Oliver and Boyd; 1954.

    Google Scholar 

  29. Bang H, Suh JH, Lee SY, Kim K, Yang EJ, Jung SH, et al. Post-polio syndrome and risk factors in korean polio survivors: a baseline survey by telephone interview. Ann Rehabil Med. 2014;38:637–47.

    Article  Google Scholar 

  30. Song KM, Choe YJ, Cho H, Bae GR, Lee JK. National action plan for response to poliovirus importation. Osong Public Health Res Perspect. 2011;2:65–71.

    Article  Google Scholar 

  31. Groce NE, Banks LM, Stein MA. Surviving polio in a post-polio world. Soc Sci Med. 2014;107:171–8.

    Article  Google Scholar 

  32. USA: Kaiser Daily Global Health Policy Report. WHO survey shows low knowledge level, acceptance of polio vaccine among Pashtun Pakistanis. 2012. Accessed 3 Jan 2018.

  33. Naqvi AA, Naqvi SBS, Yazdani N, Ahmad R, Ahmad N, Zehra F. Understanding the dynamics of poliomyelitis spread in Pakistan. Iran J Public Health. 2017;47:997–8.

    Google Scholar 

  34. The Express Tribune. 80% of polio cases linked to Pashtun community: health minister. 2014. Accessed 25 Dec 2017.

  35. WHO declares Peshawar world’s ‘largest reservoir’ of polio. 2014. Accessed 24 Dec 2017.

  36. Naqvi AA, Naqvi SBS, Shahid S, Yazdani N. Barriers to rehabilitation treatment among poliomyelitis infected patients in Karachi, Pakistan: a mix-methods study. Khyber Med Univ J. 2016;8(1):12–21.

    Google Scholar 

  37. Khan MA, Kanwal N. Is unending polio because of religious militancy in Pakistan? A case of Federally Administered Tribal Areas. Int J Dev Conflict. 2015;5:32–47.

    CAS  Google Scholar 

  38. McNeil DG Jr. Polio: eradication efforts in Pakistan put focus on high-risk Pashtun community. The New York Times. 2012. Accessed 1 Dec 2017.

  39. Sheikh A, Iqbal B, Ehtamam A, Rahim M, Shaikh HA, Usmani HA, et al. Reasons for non-vaccination in pediatric patients visiting tertiary care centers in a polio-prone country. Arch Public Health. 2013;71:19.

    Article  Google Scholar 

  40. Pakistan Bureau of Statistics (PBS). Household integrated economic survey (HIES) 2015/16. 2017. Accessed 5 Mar 2018.

  41. Werhagen L, Borg K. Analysis of long-standing nociceptive and neuropathic pain in patients with post-polio syndrome. J Neurol. 2010;257:1027–31.

    Article  Google Scholar 

  42. Bertolasi L, Danese A, Monaco S, Turri M, Borg K, Werhagen L. Polio patients in northern Italy, a 50 year follow-up. Open Neurol J. 2016;10:77–82.

    CAS  Article  Google Scholar 

  43. Naeem H. Understanding Pakistani culture. Bloomington: Author House; 2012.

    Google Scholar 

  44. Sheikh A, Ali S, Ejaz S, Farooqi M, Ahmed SS, Jawaid I. Malpractice awareness among surgeons at a teaching hospital in Pakistan. Patient Saf Surg. 2012;6:26.

    Article  Google Scholar 

  45. Yousafzai AW. Corruption in medical practice: where do we stand? J Ayub Med Coll Abbottabad. 2015;27:515–6.

    PubMed  Google Scholar 

  46. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. The Global Burden of Disease: a comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020. Oxford: Oxford University; 2006.

    Book  Google Scholar 

  47. Zeilig G, Weingarden H, Shemesh Y, Herman A, Heim M, Zeweker M, et al. Functional and environmental factors affecting work status in individuals with longstanding poliomyelitis. J Spinal Cord Med. 2012;35:22–7.

    Article  Google Scholar 

  48. The World Bank. Health expenditure per capita (current US$). 2015. Accessed 20 Dec 2017.

Download references


The authors would like to acknowledge and extend their gratitude to the Department of Physical Therapy, Clifton Central Hospital, and especially to Dr Muntazir Zaidi and Dr Zain Azhar for their guidance and for arranging meetings with rheumatologists and physical therapists in different cities in Pakistan. We would also like to thank the panel of experts for enlightening us with their advice at crucial stages. Finally, we would like to extend our profound gratitude to all of the patients in this study for providing their precious time and information to help our cause.

Author information

Authors and Affiliations



AAN conceived the idea and refined it with SBSN. FZ and AKV provided advice on methodological aspects. The abstract and Introduction section were written by AAN, FZ, RA, and NA. The Methodology section was jointly written by AAN, FZ, and AKV. The data collection form was jointly designed by AAN, SBSN, SU, SB, RA, and NA. SU, SB, and RA obtained permission from hospitals, collected data from patients, and entered the data in SPSS® with assistance from NA. The results were analyzed by AAN, SBSN, and FZ and the Results section written by same authors. AAN and FZ wrote the Discussion and Conclusion section. AAN, FZ, and AKV carried out the revision of the manuscript based on reviewers’ comments.

Corresponding author

Correspondence to Atta Abbas Naqvi.

Ethics declarations


No funding was obtained for this study.

Conflict of interest

Atta Abbas Naqvi, Syed Baqir Shyum Naqvi, Fatima Zehra, Ashutosh Kumar Verma, Saman Usmani, Sehrish Badar, Rizwan Ahmad, and Niyaz Ahmad declare that no conflicts of interest exist.

Ethical approval

The study was approved by the Department of Physical Therapy, Clifton Central Hospital, Karachi 75600, Pakistan (CH/2015/186) and has been performed in accordance with the ethical standards of the Declaration of Helsinki.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Data availability statement

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 23 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Naqvi, A.A., Naqvi, S.B.S., Zehra, F. et al. Estimation of the Direct Cost of Poliomyelitis Rehabilitation Treatment to Pakistani Patients: A 53-Year Retrospective Study. Appl Health Econ Health Policy 16, 871–888 (2018).

Download citation

  • Published:

  • Issue Date:

  • DOI: