Cost Minimization Analysis of Antiepileptic Drugs in Newly Diagnosed Epilepsy in 12 European Countries

Abstract

Summary: A recent United Kingdom cost minimization analysis (CMA) of four antiepileptic drugs (AEDs) used to treat newly diagnosed adult epilepsy demonstrated that a new drug, lamotrigine (LTG), incurred higher costs than carbamazepine (CBZ), phenytoin (PHT), and valproate (VPA), whose costs were similar. This analysis took account of each drug's sideeffect and tolerability profile. The present analysis investigated the costs of treatment with LTG, CBZ, PHT, and VPA in 12 European countries. Data were derived from published sources and from a panel of locally based experts. When no published data were available, estimates were obtained using expert opinion by a consensus method. These data were incorporated into a treatment pathway model, which considered the treatment of patients during the first 12 months after diagnosis. The primary outcome considered was seizure freedom, Randomized controlled trials demonstrate that the drugs considered are equally effective in terms of their ability to achieve seizure freedom, and thus the most appropriate form of economic evaluation is a CMA. These trials provided data on the incidence of side effects, dosages, and retention rates. The economic perspective taken was that of society as a whole and the analysis was calculated on an "intent-to-treat'' basis. Only direct medical costs were considered. In each country considered, LTG was twofold to threefold more expensive than the other drugs considered. A sensitivity analysis demonstrated that varying each of the assumptions (range defined by expert panels) did not significantly alter the results obtained.

Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation

“…Heaney and colleagues 253 report the costs in the first 2 years of initiating therapy, based on the trials and from an ITT perspective, to vary between £795 and £829 for CBZ, £736 and £768 for PHT, £868 and £884 for VPA and £1525 and £2076 for LTG. Heaney and colleagues 254 estimate that treating a patient with LTG as first-line therapy is between two and four times as expensive as treatment with CBZ, PHT or VPA, which share similar costs, over the first year. These results are consistent in all countries considered despite variations in the medical management of epilepsy.…”

“…253 The same authors, in collaboration with others, assessed five RCTs for a European study that was published in 2000. 254 …”

“…Bryant and Stein assessed adult patients with epilepsy, 252 but the remaining studies included only newly diagnosed patients with either partial or generalised onset epilepsy. Two studies included adolescents [253][254][255] and one focused on patients with tonic-clonic seizures.…”

“…Two studies included the cost of emergency room visits. 253,254 Combining costs and effectiveness Since the studies were all CMAs, costs were not combined with any unit of effectiveness. However, Bryant and Stein reported their findings as a cost per patient seizure free after 24 weeks of maintenance therapy, 252 although there was no between group difference in this measure.…”

Pharmacoeconomics and macular degeneration

“…A good example of cost-minimization analysis is the European study in which four epilepsy drugs (lamotrigine, carbamazepine, phenytoin and valproate), equally effective in terms of their ability to achieve seizure freedom, were compared with regard to price [2]. It was found that lamotrigine was more costly than the other three [2].…”