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This study analyzes the direct medical costs of hospitalized epilepsy patients in Thailand. These costs are assessed from both a societal perspective—which includes hospital expenditures and payments made by health insurance schemes—and a patient perspective, which accounts for out-of-pocket expenses for treatments not covered by insurance. The study also examines factors associated with these costs. Findings indicate that direct medical costs are higher from the societal perspective due to the comprehensive benefit coverage provided by health insurance schemes. Key cost drivers include length of hospital stay, presence of comorbidities or complications, and the types of medical procedures performed. The study suggests that expanding health benefit coverage could help further reduce out-of-pocket expenses for patients.