A case for free supply of antiepileptic drugs in resource-poor regions: 3-year cost effectiveness analysis of morbidity, mortality and quality of life

Lead Research Organisation: Peruvian University Cayetano Heredia
Department Name: Microbiology

Abstract

People with epilepsy suffer from lack of treatment. Free drug treatment will improve many lives at very low cost for governments. This trial will demonstrate the cost benefit of such a policy and change the lives of thousands of people and their families

Technical Summary

Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent non-communicable diseases. In poor countries the vast majority of people with epilepsy do not receive appropriate treatment for their condition because of a series of reasons, amongst which poor availability of antiepileptic drugs [AED] appears as an accessible target for intervention. This community-based cluster randomized trial (Phase IV) will evaluate the cost effectiveness of implementing free AED provision through the local health system in rural Northern Peru using a stepped wedge design directed towards cost effectiveness analysis. The study intervention is the implementation of free AED distribution in health centers. The cohort design will compare effectiveness (seizure control, decreases in mortality, improvements in quality of life), and costs in terms of person/months before and after the intervention.

We will determine the cost-effectiveness and cost-utility ratios of a population-wide policy of free distribution of antiepileptic drugs through a national health system in rural settings in a developing country. This should result in appropriate control of 70% of all epilepsies, thus potentially targeting up to 0.3% of the total burden of disease worldwide. While this policy is already enacted in several countries, most countries do not opt for it mainly because of the lack of sound cost efficacy analysis and demonstration of feasibility. This trial should provide base evidence and pave the way for free AED coverage and distribution for all rural populations in LLMICs.

Planned Impact

This trial will demonstrate the cost-effectiveness of implementing free distribution of antiepileptic drugs in developing countries. It would mean that thousands of people with epilepsy in rural areas will have access to a cheap treatment which will change the quality of their lives, that of their families, and will signifficantly decrease mortality of such a policy and change the lives of thousands of people and their families

Publications

10 25 50
 
Title Study databases 
Description Expected databases include census, epilepsy survey, AED usage data, and costs. 
Type Of Material Database/Collection of data 
Provided To Others? No  
Impact None yet 
 
Description CRESIPT 
Organisation Imperial College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Coordination for future collaborative work
Collaborator Contribution None yet
Impact None yet
Start Year 2016
 
Description Cysticercosis control in rural settings 
Organisation Oregon Health and Science University
Country United States 
Sector Academic/University 
PI Contribution Synergic work in the same region
Collaborator Contribution They help to train field workers and collaborate in field activities
Impact None yet
Start Year 2015
 
Description Community engagement 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Community engagement is part of the project activities and is initiated well before any other activity such as surveys or interventions. The study team engages with major community leaders to explain them the purpose and methods of the study and to obtain their cooperation, initiating a cascade effect
Year(s) Of Engagement Activity 2015,2016