Abstract
BackgroundThe adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. However, adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied. Therefore, the present study aimed to analyze the cost and adherence of AEDs and its associated factors in patients followed in Pakistan.MethodsData from prescriptions collected from patients with epilepsy who have visited the Outpatient Department (OPD) of different tertiary care hospitals at the cosmopolitan city of Karachi, Pakistan from December 2015 to November 2019. The mean follow-up period for each participant was about 22 months. Pairwise comparisons from Cox regression/hazard ratios were used to assess the predictors of adherence. Direct costs of AEDs were calculated and presented as the annual cost of drugs.ResultsA total of 11,490 patients were included in this study, 51.2 % were male and 48.8 % were female with a mean age of 45.2 ± 15.8 y. Levetiracetam was found as the most prescribing AED in all study participants (32.9 %). Of them, 49.1 % of patients continued their initial recommended treatment. However, 31.3 % of patients have discontinued the therapy, while, 19.6 % were switched to other AED. Adherence with initial treatment was more profound in male (57.4 %) patients, compared to female with a mean age of 44.2 years. Lamotrigine users (60.6 %) showed a higher tendency to retain on initially prescribed drugs. The total cost of epilepsy treatment in the entire study cohort was 153280.5 PKR ($941.9). By applying the Cox regression analysis, it can be observed that the patients with increasing age (OR, 2.04), migraine (OR, 2.21), psychiatric disorders (OR, 4.28), other comorbidities (OR, 1.52) and users of other than top five prescribing AEDs (2.35) were at higher risk of treatment discontinuation. However, levetiracetam (OR, 0.69), valproic acid (OR, 0.52), carbamazepine (OR, 0.81), lamotrigine (OR, 0.80) or lacosamide (OR, 0.65) users have more chances to continue their initial therapy.ConclusionsSimilar to western countries, the majority of patients with epilepsy exhibited low adherence with AEDs. Various associated factors for improving adherence were identified in this study.
Highlights
Epilepsy is a chronic brain disorder characterized by recurrent episodic seizures attacks and other psychiatric and somatic consequences [1]
2075 (15.2 %) participants were excluded because 1017 (7.5 %) were using those antiepileptic drugs (AEDs) not included in this study, 624 (4.6 %) were taking drugs as polytherapy while 434 (3.1 %) left the study during the follow-up period
Overall, the share of adherence with AED in patients with epilepsy is lower than 50 % after four years of treatment
Summary
Epilepsy is a chronic brain disorder characterized by recurrent episodic seizures attacks and other psychiatric and somatic consequences [1]. Progressive aging with time can be associated with an increase in the prevalence of epilepsy. The prevalence of this disease among the general population ranges from 2.3 to 15.9 per 1,000 in developed countries and from 3.6 to 15.4 per 1,000 in developing and underdeveloping countries [3]. The adherence pattern of antiepileptic drugs (AEDs) among patients with epilepsy is relatively lower in the United States and different European countries. Adherence and cost analysis of AEDs in Asian countries have not been thoroughly studied.
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