Affordability of newer antiseizure medications in Asian resource‐limited countries

Abstract

ObjectiveOne of the objectives of the Intersectoral Global Action Plan on epilepsy and other neurological disorders for 2022 to 2031 is to ensure at least 80% of people with epilepsy (PWE) will have access to appropriate, affordable, and safe antiseizure medications (ASMs) by 2031. However, ASM affordability is a significant issue in low‐ and middle‐income countries, preventing PWE from accessing optimal treatment. This study aimed to determine the affordability of the newer (second and third generation) ASMs in resource‐limited countries in Asia.MethodsWe conducted a cross‐sectional survey by contacting country representatives in lower‐middle‐income countries (LMICs) in Asia, including Indonesia, Lao People's Democratic Republic (PDR), Myanmar, Philippines, Vietnam, India, Bangladesh, and Pakistan, and the upper‐middle‐income country Malaysia, from March 2022 to April 2022. The affordability of each ASM was calculated by dividing the 30‐day ASM cost by the daily wage of the lowest paid unskilled laborers. Treatment costing 1 day's wage or less for a 30‐day supply of chronic disease is considered affordable.ResultsEight LMICs and one upper‐middle‐income country were included in this study. Lao PDR had no newer ASM, and Vietnam had only three newer ASMs. The most frequently available ASMs were levetiracetam, topiramate, and lamotrigine, and the least frequently available was lacosamide. The majority of the newer ASMs were unaffordable, with the median number of days' wages for a 30‐day supply ranging from 5.6 to 14.8 days.SignificanceAll new generation ASMs, whether original or generic brands, were unaffordable in most Asian LMICs.

Impact of a free medication intervention on seizure recurrence and anxious and depressive symptoms in people living with epilepsy in the Republic of Guinea

“…Drug affordability remains an ongoing challenge in countries with few resources, like Guinea. In a recent survey of nine Asian countries, levetiracetam was among the most frequently available newer ASMs; however their cost to pay for an ASM is between 5.6 and 14.8 days of wages per month [30]. The World Health Organization's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders [31] seeks inter alia to address this issue, considering each of availability, accessibility and affordability of ASMs.…”

Developing Systems of Emergency and Inpatient Neurologic Care in Resource-Limited Settings

“…16 Newer ASMs are often unaffordable in LMICs, with the median number of days' wages needed for a 30-day supply ranging between 5.6 and 14.8 days in a recent study. 49 Though inexpensive older ASMs can control seizures, their supply and quality can be inconsistent in resource-limited areas. Many older ASMs require monitoring of serum levels to ensure adequate dosing and limit toxicities, requiring trained personnel and laboratory medicine capacity that is often unavailable in rural areas.…”