To examine recent global and regional patterns and trends of antiseizure medications (ASMs) consumption and costs across high-, upper-middle-, and lower-middle-income countries (HICs, UMICs, LMICs).

Epilepsy affects over 50 million people globally, with 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.

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, while Africa lagged at 4.78 and Asia recorded the lowest at 1.98. HICs consumed more ASMs and transitioned to newer-generation ASM 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.