To estimate the costs of management of children with structuralmetabolic epilepsy and to determine the cost-driving factors in the selected population. METHODS: This was a retrospective annual prevalence-based study that included patients who attended a paediatric neurology clinic in a tertiary referral centre in Malaysia. The total costs of epilepsy management were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardised for the year 2010. RESULTS: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalisation and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the annual cost of epilepsy management. Similarly, child development and seizure type were also not associated with the cost of management. On the other hand, children who received polytherapy treatment, therapeutic drug monitoring, or adjuvant therapy with new antiepileptic drugs represented high-cost groups of patients. Moreover, the total annual cost of epilepsy management positively correlated with seizure frequency. CONCLUSIONS: This investigation was the first cost analysis study of epilepsy in Malaysia. The total annual cost of management for 120 patients with structural-metabolic epilepsy was RM 202,816 (i.e., RM 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.

in study design and the availability of evidence for value demonstration. Systematic reviews and retrospective database studies investigating the efficacy and safety of existing therapies or supportive care, which allow for qualitative comparisons against the new therapy, were generally expected by most of the respondents. Cost-effectiveness analysis was required in some of the countries, with the rest expecting only a budget-impact analysis based on local epidemiological data. Findings were similar for therapies for diseases with low prevalence but without orphan drug designation. CONCLUSIONS: Unmet needs in rare diseases are high, and effective new therapies are welcomed and valued by payers in these key reimbursed markets in Asia. Decision makers are willing to show a degree of flexibility in their evidence requirements for these kinds of products.