Availability, affordability, and quality of essential antiepileptic drugs in Lao PDR

Abstract

Objective Epilepsy is a chronic condition treatable by cost‐effective antiepileptic drugs (AEDs), but limited access to treatment was documented. The availability and affordability of good quality of AEDs play a significant role in access to good health care. This study aimed to assess the availability, affordability, and quality of long‐term AEDs in Lao PDR. Method A cross‐sectional study was performed in both public and private drug supply chains in urban and rural areas in Lao PDR. Data on AEDs 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 AEDs were collected, and the quality of AEDs was assessed through Medicine Quality Assessment Reporting Guidelines. Results Out of 237 outlets visited, only 50 outlets (21.1% [95% CI 16.1‐26.8]) had at least one AED available. The availability was significantly different between urban (24.9%) and rural areas (10.0%), P = .017. Phenobarbital 100 mg was the most available (14.3%); followed by sodium valproate 200 mg (9.7%), phenytoin 100 mg (9.7%), and carbamazepine 200 mg (8.9%). In provincial/district hospitals and health centers, AEDs were provided free of charge. In other healthcare facilities, phenytoin 100 mg and phenobarbital 100 mg showed the best affordability (1.0 and 1.2 day wages, respectively) compared to carbamazepine 200 mg (2.3 days) and other AEDs. No sample was identified as counterfeit, but 15.0% [95% CI 7.1‐26.6] of samples were classified as of poor quality. Significance We quantified and qualified the various factors contributing to the high treatment gap in Lao PDR, adding to diagnostic issues (not assessed here). Availability remains very low and phenobarbital which is the most available and affordable AED was the worst in terms of quality. A drug policy addressing epilepsy treatment gap would reduce these barriers.

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

“…The availability found in our study was lower than previous studies in other border countries such as Vietnam (>36.0% for carbamazepine and phenytoin) 36 and Thailand (above 80%) 37, 38 . In contrast, we found a higher availability and better affordability than a recent study in Lao PDR, conducted over the same period with the same methodology, and reported availability of less than 15.0% 8 . This difference could be partly explained by the type of facilities considered.…”

“…For data collection, availability and affordability endpoints, and data analysis were adapted from those used in another project performed in Lao PDR and published in 2020 8 …”

“…However, studies and routinely collected data on medicine availability and prices are still scarce, especially for the treatment of epilepsy 7 . A recent study in Lao PDR demonstrated the low availability of all essential ASM 8 . Another study in Madagascar shows that the least affordable ASM (sodium valproate) was the most available instead of phenobarbital.…”

“…7 A recent study in Lao PDR demonstrated the low availability of all essential ASM. 8 Another study in Madagascar shows that the least affordable ASM (sodium valproate) was the most available instead of phenobarbital. In the same study, original brands were more available than generic formulations.…”

“…10 Similarly, in Lao PDR, approximatively half of the sample of phenobarbital collected in 2018, which was the most available and affordable ASM, was of poor quality. 8 Besides, a study performed in sub-Saharan Africa shown that tropical environmental factors (temperature, relative humidity, light) have a strong influence on the quality of carbamazepine, phenytoin, and sodium valproate tablets. 11 Cambodia, a Southeast Asian country, has a population of 14 million people.…”