Prevalence, utilization, and costs of antiepileptic drugs for epilepsy in Germany—a nationwide population-based study in children and adults

Abstract

Nationwide analyses of drug use can provide a prevalence estimate of the underlying disease and can help in understanding the characteristics of treatment. This study aimed for such analyses regarding the utilization of antiepileptic drugs (AED) for epilepsy in Germany. In 2009, all 4,115,705 AED prescriptions of all German patients with statutory health insurance (70,011,508 persons) were retrospectively analyzed. The IMS(®) LRx database served as data source, which accesses nationwide pharmacy data centers processing all German prescription data. To establish the age and sex-specific percentage of patients taking AED because of epilepsy, we used a second database, Disease Analyzer(®), which covered a representative sample of the German population (7.2 million patients) and contained ICD10 codes alongside with prescription data. The period prevalence of patients taking AED because of epilepsy was 9.1/1,000 (children/adolescents: 5.2/1,000; elderly: 12.5/1,000). Of the patients, 83.1 % took at least one of four AED: valproate (29.8 %), carbamazepine (26.4 %), lamotrigine (21.4 %), and levetiracetam (16.9 %). Oxcarbazepine and sultiame were popular with pediatricians. Elderly patients frequently received phenytoin and primidone. More than half of the patients were treated by family physicians; 68 % took AED in monotherapy and 7.9 % received >2 AED (children/adolescents: 12.5 %). The costs for AED prescribed for epilepsy amounted to €285.1 Mio (median AED costs/patient: €158/a). The German 2009 prevalence of epileptic patients taking AED was 9.1/1,000. Family physicians cared for the majority of patients. Prevalence and prescribing patterns changed with age. Costs of AED against epilepsy added up to 1 % of total medication costs in Germany.

Trends in Antiepileptic Drug Prescriptions for Childhood Epilepsy at a Tertiary Children’s Hospital in Korea, 2001–2012

“…In Norway, the most commonly used drugs were valproic acid and lamotrigine in children in 2004-2009 [9]. In Germany, the most preferred AED was valproic acid, followed by carbamazepine and lamotrigine [10]. A cohort study from UK family practice in 2008 showed that valproic acid was most commonly prescribed, followed by lamotrigine and levetiracetam in patients 0-14 years of age [11].…”

“…These results conflicted with those from previous reports in which the use of newer AEDs increased but older AEDs remained the mainstay of treatment in children. In Germany, older AEDs were used in 70.4 % of patients, while 48.3 % received new AEDs in 2009 [10]. The use of new AEDs in epilepsy increased from 40 % in 2004 to 49 % in 2009 in Norway [9].…”

“…Although other options such as surgery and nerve stimulation are available, the use of antiepileptic drugs (AEDs) remains the mainstay of epilepsy treatment. Several epidemiological studies have evaluated AED prescribing patterns in adult and pediatric populations and reported different trends in the use of second-generation AEDs [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Prescription patterns have been evaluated most actively in European countries [3-5, 7-13, 17-19], whereas few studies have reported on AED utilization in large pediatric epilepsy cohorts in Asian countries [15,16].…”

Screening for ecotoxicological effects of antiepileptic drugs in biologically treated waste water originating from an epilepsy ward by Danio rerio embryos

“…The prevalence of epilepsy is estimated at 0.91%, and antiepileptic drugs were used by 634,566 patients in Germany in 2009 according to [28]. Since most epilepsy patients are in ambulant treatment, antiepileptic drugs can be detected in most, if not all, WWTP effluents, though data do not exist for all antiepileptic drugs.…”

Generic substitutions of antiepileptic drugs: Is it possible to put an end to the discussion?

“…Кроме то-го, следует отметить, что практически все исследователи в рамках тестирования новых стандартов изучали ламо-триджин. С нашей точки зрения, изучения в этом отноше-нии требуют и другие ПЭП, прежде всего вальпроат, оста-ющийся одним из самых широко применяемых препара-тов этой группы в мире [56][57][58][59]. В ожидании же результа-тов новых исследований при необходимости генерических замен ПЭП можно только рекомендовать использование ЛС с хорошо изученными свойствами (в том числе и фар-макокинетическими) в пределах одной и той же лекарст-венной формы.…”