Availability cost of antiepileptic and psychotropic drugs after community-based interventions in madagascar

Abstract

International audienceBackground: In Madagascar, prevalence of epilepsy is 27.3/1000 and the lifetime prevalence of mental disorders 34.0. From 2013 to 2018, interventions were carried out by the MoH to train GPs on these diseases and raise awareness among the population.Objectives: The objective was to compare the availability and cost of drugs between intervention and control areas in 8 regions of Madagascar.Methods: Data were collected from all types of points of sale (POS) for medicines (public and private). All psychotropic and antiepileptic drugs were included. The study received ethical approval from the Madagascar MoH.Results: 218 POS (82.5%) agreed to be investigated. Regarding the overall availability of AEDs, there was no significant difference between intervention and control areas (95.9% vs 94.4% of POS stocking at least one AED). There were however differences for carbamazepine (79.7% vs 53.4%) and sodium valproate (27.0% vs 11.8%) with these being available in a greater number of POS in the intervention areas (p <0.05). Phenobarbital was the most commonly stocked AED in both areas (90.5% and 88.9% p=0.7). Phenytoin was not available in any supply chain. Among psychotropic drugs, anxiolytics (89.0%) were the most frequently available overall, followed by neuroleptics (21.6%) and tricyclic antidepressants (15.6%). There were significantly more outlets in the intervention areas having tricyclic antidepressants (27.0%) and mood stabilizers (4.1%). The price of AEDs and psychotropic drugs were lower in the intervention areas, except for injectable neuroleptics.Conclusions: These results suggest greater availability and lower prices for antiepileptic and psychotropic drugs in the intervention areas. As both availability and cost of drugs can affect access to treatment, this provides a relevant focus for the national epilepsy and mental health st