Cost-effectiveness of adding-on new antiepileptic drugs to conventional regimens in controlling intractable seizures in children

Abstract

Background and purpose of the studyIntractable seizures are a subgroup of epileptic disorders challenging the physicians’ skills to become controlled. Showing resistance towards common pharmacotherapy, they demand newer antiepileptic drugs acquired at higher costs. 0.06% of children around the world are estimated to suffer from epilepsy and its consequences. The aim of the present study has been to evaluate the cost-effectiveness of these drugs in the treatment of intractable seizures in children.MethodsClinical and cost data were collected from medical and cost records preserved at a neurologist office and a referral pharmacy respectively. Based on the new AED which are accessible in Iran, regimens were categorized into eight groups. The first group consisting of conventional AEDs was considered as comparator and the effectiveness of other groups was compared with it. Incremental Cost-effectiveness Ratio (ICER) of adding-on each new antiepileptic drug was calculated in terms of Rials per consequence (Rls/consq) and compared with each other. Furthermore ICER of the regimens was compared with the GDP per capita (Gross Domestic Product) of the year (2010).Resultsthe ICER of the adding-on regimens range from negative values for Gabapentin, Levetiracetam and Zonisamide to low values for Lamotrigine (~ 6.4 million Rials/consequence [mil Rls/consq]) and Oxcarbazepine (~7.7 mil Rls/consq) and followed by high values for Topiramate (~21 mil Rls/consq) and Vigabatrin (~43.7 mil Rls/consq) considering the three months of remaining on regimen. By increasing the limit of remaining time to six months, the previously mentioned regimens persist on negative values. However Oxcarbazepine (~28.7 mil Rls/consq) and Lamotrigine (~13.8 mil Rls/consq) show a steep increase. Topiramate (~23.6 mil Rls/consq) displays a less change. Opposite to other regimens, the ICER value of Vigabatrin (~17.26 mil Rls/consq) has shown an important increase.Major conclusionsAdding-on new antiepileptics to conventional regimens are cost-effective and justified considering the GDP per capita.

A systematic review of economic evaluations of treatments for patients with epilepsy

“…They concluded that if there is a willingness to pay £150,000 per QALY, the probability of any of the newer AEDs being cost-effective is <50%. Gharibnaseri et al 34 examined the cost-effectiveness of adding on new AEDs to conventional regimens in an attempt to control intractable seizures in children. In this study, newer AEDs (i.e., gabapentin, levetiracetam, lamotrigine, oxcarbazepine, topiramate, vigabatrin, and zonisamide) compared with older AED; it was concluded that gabapentin, levetiracetam, and zonisamide were dominated by older AED.…”

“…Three studies were identified that looked at the costeffectiveness of epilepsy surgery and compared it with 35 20 2 5 90.9 Beretta et al 47 15 5 7 75.0 Blais et al 36 19 2 6 90.5 Bolin et al 23 17 5 4 77.3 Bowen et al 40 22 1 4 95.7 Chisholm et al 20 16 7 4 69.6 Chisholm et al 21 14 9 4 60.9 Clements et al 39 19 4 4 82.6 Craig et al 32 12 11 4 52.2 De Kinderen et al 44 21 2 3 91.3 De Kinderen et al 43 19 1 7 95.0 Frew et al 33 16 6 5 72.7 Gharibnaseri et al 34 16 5 6 76.2 Gureje et al 22 5 17 5 22.7 Hawkins et al 29 22 0 4 100.0 Helmers et al 45 16 5 6 76.2 Jentink et al 66 31 18 5 4 78.3 Lee et al 51 22 1 4 95.7 Lee et al 52 19 3 5 86.4 Majoie et al 46 11 8 8 57.9 Maltoni and Messori 27 18 5 4 78.3 Marson et al 17 21 1 5 95.5 Noble et al 48 19 1 7 95.0 Oldham et al 42 9 11 7 45.0 Plumpton et al 49 16 6 5 72.7 Rane et al 50 4 16 7 20.0 Remak et al 16 18 5 4 78.3 Remak et al 28 16 5 6 76.2 Simoens et al 24 23 0 4 100.0 Spackman et al 30 20 3 4 87.0 Suh and Lee 37 18 4 5 81.8 Van Hout et al 15 11 11 5 50.0 Vera-Llonch et al 26 18 5 4 78.3 Verdian et al 38 23 0 4 100.0 Widjaja et al 41 18 4 5 81.8 Average quality score: 77.0 "Yes" indicates sufficiently/correctly described and conducted in the study; "No" indicates insufficient, wrong, or no information regarding the specific topic in the study; NA, not applicable. A full description of the items can be found in Appendix S2.…”

Decision Models for Assessing the Cost Effectiveness of Treatments for Pediatric Drug-Resistant Epilepsy: A Systematic Review of Economic Evaluations

“…Ten economic evaluations met the inclusion criteria (ESM Appendix 3); however, it was unclear whether one study [25] was a model-or trial-based evaluation and it was not included in the evidence summary. Thus, the evidence base for this review comprised nine full economic evaluations based on decision models involving treatments for drug-resistant epilepsy in children [26][27][28][29][30][31][32][33][34]. No studies assessed the cost effectiveness of cannabis-based treatments for pediatric drug-resistant epilepsy.…”

Cost-effectiveness analysis review of exemestane in the treatment of primary and advanced breast cancer

“…Recently, the domestic generic exemestane entered into the market of Iran. Given the higher cost of treatment, to assess whether it is rational to add exemestane to the clinical practice guidelines and whether it is logical to be covered by national insurance, we were interested to analyze its cost-effectiveness [16–18]. In this study, cost-effectiveness of exemestane with other available alternatives such as tamoxifen, anastrozole, letrozole, and megestrol in primary and metastatic breast cancer was studied.…”