Objective: To determine the affordability, availability, geographic distribution and financing options of Parkinson’s disease (PD) medication in Ghana.

Background: In sub-Saharan Africa, patients with PD are largely left undertreated or even untreated, due to limited access to medication. There is little data on the availability and affordability of PD medications in low-to-middle income countries worldwide.

Method: In this nationwide cross-sectional study, 121 pharmacy outlets in all 10 regions of Ghana were selected to determine the availability and affordability of drugs used to treat PD using the World Health Organization/Health Action International methodology. Data was collected via in-person (52%) and phone (48%) interviews, mainly the pharmacists (69%) or the manager (21%). Public and private pharmacies were randomly selected in a 1:1 ratio. The largest public pharmacy in each region was purposefully sampled.The affordability was based on the current minimum wage of 42,58 USD/month minus taxes and cost of living, according to the Ghana Living Standards Survey.

Results: A total of 60 public and 61 private pharmacies were sampled. Anticholinergics were the most available drug (41.3%) in both public and private pharmacy outlets, followed by DA-agonists (19.0%, mostly Bromocriptine) and Levodopa (11.0%).The availability of Levodopa is low nationwide (11%), 3-fold greater in private vs. public pharmacies (14.6% vs 5.0%, respectively). Shortages/irregular supply is experienced in 52% of pharmacies. The Greater Accra (28.6%) and Ashanti (25.0%) regions had the highest Levodopa availability, while it was unavailable in 4 regions.Respondents stated cost of medicines and rareness/low awareness of PD as reasons for the low availability of medicines for PD. All medications to treat PD are not affordable, with the only exception of anticholinergics. The cost of 100 Tablets of Levodopa/Carbidopa ranges from 35 (100+10mg) to 64 (100+25mg) USD. Non ergot-derived DA-agonists are available in 0.8-1.7% of pharmacie. There is no public health financing option for PD medications in Ghana, except for anticholinergics.

Conclusion: Despite being considered a cheap medication, Levodopa is neither widely available nor affordable in Ghana. Alternative low-cost formulations and public financing policies are urgently needed to improve access to PD medications.  Acknowledgements: This survey was funded by the International Parkinson and Movement Disorder Society.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/availability-of-parkinsons-disease-medicines-in-ghana-a-national-survey/