Sengxeu Noudy, Dufat Hanh, Boumediene Farid, Vorachit Somchit, Chivorakoun Phetvongsinh, Souvong Vimalay, Manithip Chanthanom, Preux Pierre-Marie, Ratsimbazafy Voa, Jost Jeremy
INSERM Univ. Limoges, CHU Limoges IRD U1094 Tropical Neuroepidemiology Institute of Epidemiology and Tropical Neurology GEIST Limoges France.
Faculty of pharmacy University of Health sciences Vientiane Lao PDR.
Epilepsia Open. 2020 Sep 17;5(4):550-561. doi: 10.1002/epi4.12432. eCollection 2020 Dec.
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.
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.
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%), = .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.
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.
癫痫是一种可通过具有成本效益的抗癫痫药物（AEDs）进行治疗的慢性疾病，但有文献记载其治疗可及性有限。优质AEDs的可获得性和可负担性在获得良好医疗保健方面发挥着重要作用。本研究旨在评估老挝人民民主共和国长期AEDs的可获得性、可负担性和质量。
在老挝人民民主共和国城乡的公共和私人药品供应链中进行了一项横断面研究。通过药品供应商获取有关AEDs可获得性和价格的数据。可负担性估计为最低工资的政府雇员购买一个月治疗所需工作的天数。收集AEDs样本，并根据药品质量评估报告指南评估AEDs的质量。
在所走访的237个销售点中，只有50个销售点（21.1%[95%CI 16.1 - 26.8]）有至少一种AEDs可供使用。城市（24.9%）和农村地区（10.0%）的可获得性存在显著差异，P = 0.017。100毫克苯巴比妥的可获得性最高（14.3%）；其次是200毫克丙戊酸钠（9.7%）、100毫克苯妥英（9.7%）和200毫克卡马西平（8.9%）。在省级/地区医院和卫生中心，AEDs是免费提供的。在其他医疗机构中，与200毫克卡马西平（2.3天工资）和其他AEDs相比，100毫克苯妥英和100毫克苯巴比妥的可负担性最佳（分别为1.0和1.2天工资）。未发现有假冒样本，但15.0%[95%CI 7.1 - 26.6]的样本被归类为质量较差。
我们对导致老挝人民民主共和国高治疗差距的各种因素进行了量化和定性，补充了诊断问题（此处未评估）。可获得性仍然非常低，最易获得且最具可负担性的AED苯巴比妥在质量方面却是最差的。一项解决癫痫治疗差距的药物政策将减少这些障碍。
