Availability, affordability, and quality of essential anti‐seizure medication in Cambodia

Abstract

Objective Epilepsy is a major neurological disorder that requires long‐term medical treatment. Once epilepsy is diagnosed, people with epilepsy face many difficulties in accessing treatment (treatment gap). Our objective was to assess the situation regarding the availability, price, affordability, and quality of anti‐seizure medication (ASM), which are major determinants of access to treatment. Method A cross‐sectional study was performed in provincial/district hospitals and private pharmacies in urban and rural areas in Cambodia. Data on ASM availability and price were obtained through drug suppliers. Affordability was estimated as the number of day wages the lowest‐paid government employee must work to purchase a monthly treatment. Samples of ASM were collected, and the quality of ASM was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 138 outlets visited, only 72 outlets (52.2% [95% CI 43.5‐60.7]) had at least one ASM available. Phenobarbital 100 mg was the most available (35.5%), followed by carbamazepine 200 mg (21.7%), phenobarbital 50 mg (11.6%), sodium valproate 500 mg (9.4%), and phenytoin 100 mg (9.4%). In provincial/district hospitals, ASM was provided free of charge. In private pharmacies, affordability for phenobarbital 50 mg and 100 mg was the best, with 0.6 and 0.5 days, respectively, compared to phenytoin 100 mg (1.8 days), and other ASM. No counterfeit ASM was found in this study. Phenytoin sample presented the worst quality (33.0%) compared to carbamazepine (27.8%), and other ASM. Significance A lack of access to affordable and effective ASM due to low availability and poor quality of ASM was identified. Our research highlights the need for future policy efforts to ensure the quality of ASM and improve their availability. This can be achieved by involving the calculation of their annual needs for these drugs and increasing the national production of ASM.

Availability, price, and affordability of antiseizure medicines in Addis Ababa, Ethiopia

“…Despite this, the availability of individual medicine was better than availability in many low‐ and middle‐income countries like Zambia, 16 Madagascar, 17 Lao PDR, 18 and India 19 . The availability was similar to the Cambodia study 20 and lower than the Cuba finding 21 …”

“…19 The availability was similar to the Cambodia study 20 and lower than the Cuba finding. 21 The availability of LPG antiseizure medicines was 62.86%, 30%, 55%, and 50% at public, private, Red Cross, and Kenema public pharmacies, respectively. The results showed that antiseizure medicines were more available in the public sector.…”

Affordability of newer antiseizure medications in Asian resource‐limited countries

“…Previous studies showed most essential ASMs, except for phenytoin 100 mg in Lao PDR, carbamazepine 200 mg in Lahore, Pakistan, and phenobarbitone 50 and 100 mg in private pharmacies in Cambodia were not affordable. [13][14][15][16][17][18] There was an obvious trend that ASM was more available in public hospitals and limited or unavailable in private sectors or retail pharmacies. [15][16][17] However, the findings from these studies might reflect the tip of the iceberg in the context of the availability and affordability of all ASMs.…”

“…[13][14][15][16][17][18] There was an obvious trend that ASM was more available in public hospitals and limited or unavailable in private sectors or retail pharmacies. [15][16][17] However, the findings from these studies might reflect the tip of the iceberg in the context of the availability and affordability of all ASMs. As newer ASMs are highly costly, they are not freely available in public hospitals or covered by national health insurance schemes.…”

“…Availability and affordability of ASMs are the two key factors needed to achieve seizure freedom and better quality of life among PWE. Previous studies showed most essential ASMs, except for phenytoin 100 mg in Lao PDR, carbamazepine 200 mg in Lahore, Pakistan, and phenobarbitone 50 and 100 mg in private pharmacies in Cambodia were not affordable 13–18 . There was an obvious trend that ASM was more available in public hospitals and limited or unavailable in private sectors or retail pharmacies 15–17 …”