Addressing the affordability of epilepsy treatment in IndiaIntroduction of access program Livefree

Among emerging countries worldwide, India continues to be a growth story. The Indian economy has grown sizably in recent times, but on the other hand income disparity has become wider during the last two decades. India’s income pyramid is divided into 5 segments – below poverty line, lower middle, upper middle, rich and super rich. The Indian income pyramid is in a dynamic state as affluence is rising. With rising affluence, the below poverty line segment at the bottom of the pyramid is shrinking continuously, and with increasing income across the income groups, the pyramid is moving upwards over time. The biggest change has been observed in the below poverty line segment wherein a huge share of the population has moved upwards to enter the ‘lower middle’ segment. A substantial shift has also been observed among the ‘lower middle’ and ‘upper middle’ segments.
With the above income dynamics in mind, Eisai Pharmaceuticals India Pvt. Ltd. (Eisai India) developed a special patient access program “Livefree” for Zonegran (zonisamide), an antiepileptic drug. The access program was built taking into consideration the income pyramid of India and aims to address the issue of ‘affordability’ among the Indian population.
Epilepsy is one of the most common neurological diseases worldwide, and nearly 80% of patients with epilepsy live in low- and middle-income countries. According to World Health Organization, about 75% of the patients don’t have access to treatment, resulting in a high DALY (disability-adjusted life year)¹ burden for epilepsy. In India, up to 12 million patients, or approximately 1% of the total population, suffer from epilepsy. Epilepsy treatment in India is marred by huge treatment gaps. It is estimated that almost 90% of patients in rural India do not have access to epilepsy treatment, while in urban areas it is around 26%.²

About 500 different antiepileptic drugs have been launched throughout the last decade in India, but over 40% patients remain refractory to the existing options and this continues to remain a major challenge for the treatment of epilepsy. In particular, there are two other major challenges. First, there is limited diagnostic support as many of the patients are not able to afford even a basic EEG (electroencephalogram) test. The second challenge is non-compliance, such as discontinuation of treatment by patient without doctor’s advice. The non-compliance with treatment can be attributed to the following:

• ● Cost of the therapy
• ● Poor disease awareness
• ● Side effects of the antiepileptic drugs
• ● Duration of the treatment and associated misconceptions
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• However, many studies in India have shown that the cost of drugs is the biggest reason for non-compliance³. India is a large “Out-of-Pocket” healthcare market with more than 80% of patients not covered by insurance, who have to bear the cost of therapy. Patients are unable to afford long-term therapy and hence they often drop out from treatment.
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• Livefree Concept

• While some efforts have been made by various stakeholders in improving awareness and educating patients about epilepsy, these efforts unfortunately do not address the biggest concern - cost of therapy.
  Guided by our corporate philosophy of hhc (human health care), Livefree is a one-of-a-kind initiative in the central nervous system therapy segment in India to help patients improve compliance with treatment using antiepileptic drugs.
  The basic objective of Livefree is to improve access to medicines for patients with lower financial ability and to improve adherence to treatment by sharing the cost burden. The program is designed for patients in need, for whom the cost is a burden and affects the continuity of therapy due to its long term treatment schedule.
  The Livefree initiative was launched in 2017 to improve access to medicines for epilepsy patients on Zonegran therapy. It has three major focus areas:
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• ● Cost Subsidy: Subsidize the cost of therapy for patients in need and thus help with continuity of treatment
• ● Therapy Monitoring: Help patients in need by providing free EEG tests from time to time as needed
• ● Disease Management: Improve awareness of the disease and improve compliance by providing various kinds of support and other tools
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                                                                             The Livefree poster in clinic in India

Eisai India is looking forward to expanding the horizons of Livefree to bring more and more patients under its ambit, as well as developing more solutions to support patients and improve access to medicines.

¹ DALY (disability-adjusted life year): One DALY can be thought of as one lost year of "healthy" life. The sum of these DALYs across the population, or the burden of disease, can be thought of as a measurement of the gap between current health status and an ideal health situation, according to WHO.
² Global disparities in the epilepsy treatment gap: a systematic review. 2010, Bull World Health Organization.
³ Das K et al Evaluation of Socio-economic factors causing discontinuation of epilepsy treatment resulting in seizure recurrence: a study in an urban epilepsy clinic in India; Seizure. 2007 Oct; 16(7):601-7)