Costs for Epilepsy Drugs Far Exceed Wages in Low-Income, War-Torn Countries

September 16, 2010 (San Francisco, California) — The cost for first-line drugs that can decrease mortality and morbidity from epilepsy remains beyond the grasp of many people worldwide, particularly those in developing and war-torn countries, according to new research unveiled here at the American Neurological Association 135th Annual Meeting.

In a survey of 82 member countries of the World Health Organization (WHO), researchers found that costs for most first-line epilepsy drugs in some countries could exceed 100% of the monthly wages for the lowest-paid workers, such as bakers or laborers, said lead author Farrah Mateen, MD, a fellow in the Department of Neurology in the Division of Infectious Disease and Neuroimmunology at Johns Hopkins University, Baltimore, Maryland.

"In countries such as Myanmar — a low-income country suffering a lot of upheaval — the cost of only one first-line antiepileptic medication, phenobarbital, does not exceed 100% of the monthly income for the lowest paid workers," she said. Other epilepsy medications, including phenytoin, valproic acid, and carbamazepine, cost more than 100% of the monthly wages in countries such Egypt and Cambodia, as well as Myanmar, Dr. Mateen said.

Lowest Wages, Highest Costs

In their research, Dr. Mateen and Tarun Dua, MD, from WHO, also found that lower-middle-income countries have some of the highest costs for epilepsy medications. These costs are problematic because middle-income countries have neither a large population with high income nor resources bolstered by international aid, Dr. Mateen said.

She noted that the global cost to treat the estimated 50 million people with epilepsy worldwide does not exceed $6 million (in US dollars) per day, and that this goal is achievable.

"First-line antiepileptic drug treatment should be made universally affordable," she said. Yet in developing countries, people with epilepsy often suffer premature and higher mortality than those in higher-income countries because of barriers to treatment, including cost for drugs and diagnosis, Dr. Mateen said.

In the study, the researchers asked all member states of WHO to report costs for a median daily defined dose of available drugs for epilepsy in their local currency in 2005. Physicians, nurses, and representatives of nongovernmental organizations with a special interest in epilepsy from 82 countries responded to the mailed surveys. Costs were converted from local currency to US and international dollars for comparison, and wages were determined using an international labor database.

Cost for a typical daily dose of antiepileptic medication ranged from just a few pennies in some countries to more than $27, the researchers found. Developing counties with the highest costs for first-line epilepsy drugs were Iraq, Peru, Fiji, and the Syrian Arab Republic.

Although their research did not delve into the reasons for the cost disparities between countries, Dr. Mateen said pharmaceutical expenses could partly be explained by limited drug manufacturing, high import costs, or difficulties in getting drugs distributed in a population affected by war.

Access Important

"The issue of accessibility to antiepileptic drugs is of enormous importance, because we know there is a huge treatment gap across countries throughout the globe," said Dan Lowenstein, MD, professor and vice chair of the Department of Neurology at the University of California–San Francisco and director of the university's epilepsy center.

"There's a lot of effort now going into doing a better job of identifying patients who might benefit from antiepileptic drugs," he told Medscape Medical News.

"This study is one of the first to do a very careful analysis of the actual costs of antiepileptic drugs across a number of different countries at different levels of economic development as it relates to actual earnings. It gives us important data for making treatment decisions," he said.

Dr. Lowenstein commented that although phenobarbital is often avoided by American physicians, it is one of the cheapest drugs to prescribe worldwide and has the advantage of once-a-day dosing, which can improve compliance. "It costs just pennies a day, but it's not even in our top 5 epilepsy drugs in the United States, because many physicians are wary of the cognitive side effects," he said.

The study was supported by an American Academy of Neurology Foundation 2010 Practice Research Fellowship Grant. Dr. Mateen and Dr. Lowenstein have disclosed no relevant financial relationships.

American Neurological Association 135th Annual Meeting: Abstract T-4. Presented September 14, 2010.