Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries

Alexandra Cameron, Amit Bansal, Tarun Dua, Suzanne R. Hill, Solomon L. Moshe, Aukje K. Mantel-Teeuwisse, Shekhar Saxena

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Purpose: In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap. Methods: Data for five AEDs (phenytoin, carbamazepine, valproic acid, phenobarbital, and diazepam) were obtained from facility-based surveys conducted in 46 countries using the World Health Organization/Health Action International (WHO/HAI) methodology. Outcome measures were percentage availability, ratios of local prices to international reference prices, and number of days' wages needed by the lowest-paid unskilled government worker to purchase treatment. Prices were adjusted for inflation/deflation and purchasing power parity. Key Findings: The average availability of generic AEDs in the public sector was <50% for all medicines except diazepam injection. Private sector availability of generic oral AEDs ranged from 42.2% for phenytoin to 69.6% for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 4.95 and 17.50 times higher than international reference prices, respectively, whereas private sector patient prices were 11.27 and 24.77 times higher, respectively. For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest income countries. The lowest-paid government worker would need wages from 1-2.6 days' to purchase a month's supply of phenytoin, whereas carbamazepine would cost 2.7-16.2 days' wages. Despite its widespread use in LMICs, WHO/HAI survey data for phenobarbital was only available from a small number of countries. Significance: In LMICs, availability and affordability of AEDs are poor and may be acting as a barrier to accessing treatment for epilepsy. Ensuring a consistent supply of AEDs at an affordable price should be a priority.

Original languageEnglish (US)
Pages (from-to)962-969
Number of pages8
JournalEpilepsia
Volume53
Issue number6
DOIs
StatePublished - Jun 2012

Fingerprint

Anticonvulsants
Phenytoin
Salaries and Fringe Benefits
Carbamazepine
Phenobarbital
Private Sector
Public Sector
Diazepam
Epilepsy
Generic Drugs
Economic Inflation
Health
Valproic Acid
Therapeutics
Parity
Outcome Assessment (Health Care)
Costs and Cost Analysis
Injections

Keywords

  • Affordability
  • Antiepileptic drugs
  • Availability
  • Developing countries
  • Epilepsy
  • Generics
  • Medicines
  • Originator brands
  • Pharmaceuticals
  • Price
  • Treatment gap

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Cameron, A., Bansal, A., Dua, T., Hill, S. R., Moshe, S. L., Mantel-Teeuwisse, A. K., & Saxena, S. (2012). Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries. Epilepsia, 53(6), 962-969. https://doi.org/10.1111/j.1528-1167.2012.03446.x

Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries. / Cameron, Alexandra; Bansal, Amit; Dua, Tarun; Hill, Suzanne R.; Moshe, Solomon L.; Mantel-Teeuwisse, Aukje K.; Saxena, Shekhar.

In: Epilepsia, Vol. 53, No. 6, 06.2012, p. 962-969.

Research output: Contribution to journalArticle

Cameron, A, Bansal, A, Dua, T, Hill, SR, Moshe, SL, Mantel-Teeuwisse, AK & Saxena, S 2012, 'Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries', Epilepsia, vol. 53, no. 6, pp. 962-969. https://doi.org/10.1111/j.1528-1167.2012.03446.x
Cameron, Alexandra ; Bansal, Amit ; Dua, Tarun ; Hill, Suzanne R. ; Moshe, Solomon L. ; Mantel-Teeuwisse, Aukje K. ; Saxena, Shekhar. / Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries. In: Epilepsia. 2012 ; Vol. 53, No. 6. pp. 962-969.
@article{22d287d10f78482fa535757f3b584f79,
title = "Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries",
abstract = "Purpose: In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap. Methods: Data for five AEDs (phenytoin, carbamazepine, valproic acid, phenobarbital, and diazepam) were obtained from facility-based surveys conducted in 46 countries using the World Health Organization/Health Action International (WHO/HAI) methodology. Outcome measures were percentage availability, ratios of local prices to international reference prices, and number of days' wages needed by the lowest-paid unskilled government worker to purchase treatment. Prices were adjusted for inflation/deflation and purchasing power parity. Key Findings: The average availability of generic AEDs in the public sector was <50{\%} for all medicines except diazepam injection. Private sector availability of generic oral AEDs ranged from 42.2{\%} for phenytoin to 69.6{\%} for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 4.95 and 17.50 times higher than international reference prices, respectively, whereas private sector patient prices were 11.27 and 24.77 times higher, respectively. For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest income countries. The lowest-paid government worker would need wages from 1-2.6 days' to purchase a month's supply of phenytoin, whereas carbamazepine would cost 2.7-16.2 days' wages. Despite its widespread use in LMICs, WHO/HAI survey data for phenobarbital was only available from a small number of countries. Significance: In LMICs, availability and affordability of AEDs are poor and may be acting as a barrier to accessing treatment for epilepsy. Ensuring a consistent supply of AEDs at an affordable price should be a priority.",
keywords = "Affordability, Antiepileptic drugs, Availability, Developing countries, Epilepsy, Generics, Medicines, Originator brands, Pharmaceuticals, Price, Treatment gap",
author = "Alexandra Cameron and Amit Bansal and Tarun Dua and Hill, {Suzanne R.} and Moshe, {Solomon L.} and Mantel-Teeuwisse, {Aukje K.} and Shekhar Saxena",
year = "2012",
month = "6",
doi = "10.1111/j.1528-1167.2012.03446.x",
language = "English (US)",
volume = "53",
pages = "962--969",
journal = "Epilepsia",
issn = "0013-9580",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Mapping the availability, price, and affordability of antiepileptic drugs in 46 countries

AU - Cameron, Alexandra

AU - Bansal, Amit

AU - Dua, Tarun

AU - Hill, Suzanne R.

AU - Moshe, Solomon L.

AU - Mantel-Teeuwisse, Aukje K.

AU - Saxena, Shekhar

PY - 2012/6

Y1 - 2012/6

N2 - Purpose: In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap. Methods: Data for five AEDs (phenytoin, carbamazepine, valproic acid, phenobarbital, and diazepam) were obtained from facility-based surveys conducted in 46 countries using the World Health Organization/Health Action International (WHO/HAI) methodology. Outcome measures were percentage availability, ratios of local prices to international reference prices, and number of days' wages needed by the lowest-paid unskilled government worker to purchase treatment. Prices were adjusted for inflation/deflation and purchasing power parity. Key Findings: The average availability of generic AEDs in the public sector was <50% for all medicines except diazepam injection. Private sector availability of generic oral AEDs ranged from 42.2% for phenytoin to 69.6% for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 4.95 and 17.50 times higher than international reference prices, respectively, whereas private sector patient prices were 11.27 and 24.77 times higher, respectively. For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest income countries. The lowest-paid government worker would need wages from 1-2.6 days' to purchase a month's supply of phenytoin, whereas carbamazepine would cost 2.7-16.2 days' wages. Despite its widespread use in LMICs, WHO/HAI survey data for phenobarbital was only available from a small number of countries. Significance: In LMICs, availability and affordability of AEDs are poor and may be acting as a barrier to accessing treatment for epilepsy. Ensuring a consistent supply of AEDs at an affordable price should be a priority.

AB - Purpose: In low- and middle-income countries (LMICs), a large proportion of people with epilepsy do not receive treatment. An analysis of the availability, price, and affordability of antiepileptic drugs (AEDs) was conducted to evaluate whether these factors contribute to the treatment gap. Methods: Data for five AEDs (phenytoin, carbamazepine, valproic acid, phenobarbital, and diazepam) were obtained from facility-based surveys conducted in 46 countries using the World Health Organization/Health Action International (WHO/HAI) methodology. Outcome measures were percentage availability, ratios of local prices to international reference prices, and number of days' wages needed by the lowest-paid unskilled government worker to purchase treatment. Prices were adjusted for inflation/deflation and purchasing power parity. Key Findings: The average availability of generic AEDs in the public sector was <50% for all medicines except diazepam injection. Private sector availability of generic oral AEDs ranged from 42.2% for phenytoin to 69.6% for phenobarbital. Public sector patient prices for generic carbamazepine and phenytoin were 4.95 and 17.50 times higher than international reference prices, respectively, whereas private sector patient prices were 11.27 and 24.77 times higher, respectively. For both medicines, originator brand prices were about 30 times higher. The highest prices were observed in the lowest income countries. The lowest-paid government worker would need wages from 1-2.6 days' to purchase a month's supply of phenytoin, whereas carbamazepine would cost 2.7-16.2 days' wages. Despite its widespread use in LMICs, WHO/HAI survey data for phenobarbital was only available from a small number of countries. Significance: In LMICs, availability and affordability of AEDs are poor and may be acting as a barrier to accessing treatment for epilepsy. Ensuring a consistent supply of AEDs at an affordable price should be a priority.

KW - Affordability

KW - Antiepileptic drugs

KW - Availability

KW - Developing countries

KW - Epilepsy

KW - Generics

KW - Medicines

KW - Originator brands

KW - Pharmaceuticals

KW - Price

KW - Treatment gap

UR - http://www.scopus.com/inward/record.url?scp=84861792860&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84861792860&partnerID=8YFLogxK

U2 - 10.1111/j.1528-1167.2012.03446.x

DO - 10.1111/j.1528-1167.2012.03446.x

M3 - Article

C2 - 22432967

AN - SCOPUS:84861792860

VL - 53

SP - 962

EP - 969

JO - Epilepsia

JF - Epilepsia

SN - 0013-9580

IS - 6

ER -