Trends in Older versus Newer Antiseizure Medications Consumption and Cost in 73 countries, 2012-2022

Background Epilepsy affects over 50 million people globally, with antiseizure medications (ASMs) as the main pharmacotherapies. Understanding disparities in ASM use and costs across income levels is critical to address inequities in epilepsy care and reduce its global burden. Objective To examine recent global and regional patterns and trends of ASM consumption and costs across high-, upper-middle-, and lower-middle-income countries (HICs, UMICs, LMICs). Methods We analyzed country-level pharmaceutical sales data from the IQVIA Multinational Integrated Data Analysis System (IQVIA-MIDAS) database spanning 73 countries, stratified by geographical regions (Africa, Asia, Europe, Latin America and the Caribbean, Northern America, Oceania), World Bank income levels (HICs, UMICs, LMICs) and ASM generations (older- and newer-generation). Drug consumption was measured using defined daily doses per 1000 inhabitants per day (DDDTID) and drug cost was calculated in USD and international dollars per DDD to account for differences in purchasing power parity (PPP). Results Global ASM consumption rose steadily from 3.10 to 3.95 DDDTID between 2012 and 2022 with a compound annual growth rate of 2.34%. Regionally, Northern America led with the highest consumption at 15.48 DDDTID in 2022, followed by Oceania at 11.19 and Europe at 8.73, whileAfrica lagged at 4.78 and Asia recorded the lowest at 1.98. HICs consumed more ASMs and transitioned to newer-generationASM by 2017, whereas MICs continued to rely heavily on older ASMs. Costs of older-generation ASMs remained low across all regions, while newer-generation ASMs showed significantly higher and more variable costs, especially when adjusted for purchasing power parity. Notably, the PPP-adjusted costs of newer-generation ASMs were substantially higher in UMICs than in HICs or LMICs. Conclusions Newer ASMs consumption has surpassed older ASMs in the mid-2010s in HICs, while UMICs and LMICs rely on older ASMs due to cost barriers. Global health policies must prioritize affordable access to newer ASMs in middle-income countries to enhance equity in epilepsy and broader neurological care.