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Fong SL, Thuy Le MA, Lim KS, Khosama H, Ohnmar O, Savath S, Mogal Z, Cabral-Lim L, Hung SKY, Asranna A, Hussain ME, Ng CW, Tan CT. Affordability of newer antiseizure medications in Asian resource-limited countries. Epilepsia 2023; 64:2116-2125. [PMID: 37243851 DOI: 10.1111/epi.17668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE One 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. METHODS We 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. RESULTS Eight 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. SIGNIFICANCE All new generation ASMs, whether original or generic brands, were unaffordable in most Asian LMICs.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Minh-An Thuy Le
- Department of Neurology, Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Kheng-Seang Lim
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Herlyani Khosama
- Neurology Department, Faculty of Medicine, University Sam Ratulangi, Manado, Indonesia
| | - Ohnmar Ohnmar
- Department of Neurology, Yangon General Hospital/University of Medicine 1, Yangon, Myanmar
| | - Say Savath
- Department of Medicine, Mittaphab Hospital, Vientiane, Lao People's Democratic Republic
| | - Zarine Mogal
- National Epilepsy Center, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Leonor Cabral-Lim
- Department of Neurosciences, College of Medicine-Philippine General Hospital, Health Sciences Center, University of the Philippines, Manila, Philippines
| | | | - Ajay Asranna
- National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Chiu-Wan Ng
- Social and Preventive Medicine Department, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong-Tin Tan
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Fong SL, Suppiah PD, Tee SK, Khoo CS, Tan HJ, Hung SKY, Looi I, Lim KS. Seizure remission rates remain low in a resource-limited country, a multicentre comparison study in Malaysia. J Clin Neurosci 2022; 102:60-64. [PMID: 35728396 DOI: 10.1016/j.jocn.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 11/26/2022]
Abstract
Seizure remission rates of 60% with antiseizure medications were reported in developed countries, but might be lower in resource-limited countries. The challenges in epilepsy care in resource-limited regions were highlighted 10 years ago, and still remain an ongoing issue. This study aimed to determine the seizure freedom rates in level-2 epilepsy care centres (centres with general neurologists) compared to level-3/4 centres (centres with epileptologists providing epilepsy surgery evaluation) in Malaysia. This is a retrospective study of 1,347 adult epilepsy patients from two level-2 (n = 290) and two level-3/4 epilepsy care centres (n = 1,057). The seizure remission rates were significantly lower in level-2 centres (42.5%) compared to the level 3/4 centres (61.9%, p < 0.05). Level-2 centres had significantly more patients with undetermined seizure types compared to level-3/4 centres (6.6% vs 3.1%, p < 0.05). Level-3/4 centres had significantly more patients with epilepsy of structural and genetic origins, whereas more patients in level-2 centres had unknown aetiology (46.2% vs. 34.0% in level-3/4, p < 0.05). Level-2 centres had a lower neurologist-to-patient ratio (1:97 vs. 1:50 in level-3/4 centres, p < 0.05). Level-2 centres also had fewer patients, who underwent investigations such as EEG (74.1% vs. 89.6%) and brain MRI (54.1% vs. 72.4%, p < 0.05) in comparison with level-3/4 centres. Our study emphasized the existing challenges in epilepsy care in a resource-limited country to achieve the ideal 60% seizure remission rate.
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Affiliation(s)
- Si-Lei Fong
- Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | | | - Sow-Kuan Tee
- Department of Medicine, Tengku Ampuan Rahimah Hospital, Selangor, Malaysia
| | - Ching-Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hui-Jan Tan
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Irene Looi
- Clinical Research Centre, Seberang Jaya Hospital, Penang, Malaysia; Department of Medicine, Seberang Jaya Hospital, Penang, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
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Fong SL, Imran Idris M, Kar-Yan Hung S, Han-Sim Ng B, Chooi KC, Ratna Vethakkan S, Tan CY. P-PN020. Acute flaccid paralysis: Guillain-Barré Syndrome mimics. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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