ArticleBMC health services research2021
Analysis of treatment adherence and cost among patients with epilepsy: a four-year retrospective cohort study in Pakistan.
Article in BMC health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Factors Associated With Antiseizure Medication Adherence in Patients With Epilepsy: A Systematic Review.Brain and behavior · 2026Pooled it
- Understanding the impact of valproate on male fertility: insights from preclinical and clinical meta-analysis.BMC pharmacology & toxicology · 2024Pooled it
- Clinical Predictors of Drug-Resistant Epilepsy in Adults: An Analytical Observational Study.Cureus · 2026Article
- Micronutrient antioxidant supplementation alleviates valproic acid-induced oxidative stress and male infertility via the NRF2/HO-1 pathway.Redox biology · 2025Article
- Observational
- Assistive Artificial Intelligence in Epilepsy and Its Impact on Epilepsy Care in Low- and Middle-Income Countries.Brain sciences · 2025Review
- Multicentric study of adherence to antiseizure medications among adults with epilepsy attended in neurology departments in Burkina Faso.Epilepsia open · 2025Article
- Impact of co-morbid common mental disorder symptoms in people with epilepsy in Ethiopia on quality of life and functional disability: a cohort study.Global mental health (Cambridge, England) · 2025Article
- Medication compliance of children with epilepsy: a cross-sectional survey.Italian journal of pediatrics · 2023Article
- Postoperative Seizure Prophylaxis in Meningioma Resection: A Systematic Review and Meta-Analysis.Diagnostics (Basel, Switzerland) · 2023Review
- Perceived stigma, discrimination and psychological problems among patients with epilepsy.Frontiers in psychiatry · 2022Article
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Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
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.
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