Objective

Newer antiepileptic drugs (AEDs) are expected to have less adverse effects (AEs) and drug interactions as compared to conventional AEDs but the high cost is the major limitation for their use. This study evaluated variation in the cost of treatment with newer and conventional AEDs through its correlation with treatment efficacy and AEs in persons with epilepsy (PWE).

Methods

This cross-sectional study included PWE (28.9 ± 9.9 years) having focal and generalized seizures on conventional [valproate, carbamazepine, phenytoin] or newer AEDs [levetiracetam, oxcarbazepine] for >6 months. Seizure frequency during the study (6 months) was compared to that within 6 months before the study. Other parameters assessed were Quality of life in epilepsy, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of life Index, and Liverpool AEs Profile. The cost of treatment was determined as direct, indirect, and intangible costs. The incremental cost-effectiveness ratio (ICER) analysis was also performed.

Results

Out of 214 PWE, 51.4% were on newer AEDs. Newer and conventional AEDs did not differ significantly in seizure frequency reduction (60.29 vs. 53.09%), quality of life parameters, though these were improved significantly during the study period. The direct medical cost and total cost of treatment were lesser with conventional AEDs (p < 0.001 in both) than newer AEDs, but the intangible cost did not differ. The total cost of treatment was significantly influenced by factors (as per regression analysis) including the type of AEDs (significant difference between valproate, carbamazepine, and levetiracetam), frequency of seizures, cost of medicine (70.34% of total cost), hospital admission, and treatment of AEs. As per ICER, newer AEDs need an additional USD 8.39 per unit reduction in seizure frequency.

Conclusion

Newer AEDs have comparatively better efficacy, though not significant than conventional AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in epilepsy treatment.

中文翻译：

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需要对癫痫患者进行抗癫痫药物单药治疗的药物经济学考虑

客观的

与传统 AED 相比，新型抗癫痫药物 (AED) 的副作用 (AE) 和药物相互作用预计较少，但高成本是其使用的主要限制。本研究通过其与癫痫患者 (PWE) 的治疗效果和 AE 的相关性评估了新型和传统 AED 治疗成本的变化。

方法

这项横断面研究包括 PWE（28.9 ± 9.9 年）在使用常规 [丙戊酸盐、卡马西平、苯妥英] 或新型 AED [左乙拉西坦、奥卡西平] 超过 6 个月时出现局灶性和全身性癫痫发作。将研究期间（6 个月）的癫痫发作频率与研究前 6 个月内的癫痫发作频率进行比较。评估的其他参数包括癫痫患者的生活质量、匹兹堡睡眠质量指数、胃肠道生活质量指数和利物浦 AEs Profile。治疗成本被确定为直接成本、间接成本和无形成本。还进行了增量成本效益比 (ICER) 分析。

结果

在 214 名 PWE 中，51.4% 使用了较新的 AED。新型和传统 AED 在癫痫发作频率降低（60.29% 对 53.09%）、生活质量参数方面没有显着差异，尽管这些在研究期间得到了显着改善。传统 AED 的直接医疗成本和总治疗成本（两者均 p < 0.001）低于新型 AED，但无形成本没有差异。治疗的总费用受到因素（根据回归分析）的显着影响，包括 AED 的类型（丙戊酸盐、卡马西平和左乙拉西坦之间的显着差异）、癫痫发作的频率、药物费用（占总费用的 70.34%）、住院，以及 AE 的治疗。根据 ICER，较新的 AED 每减少一次癫痫发作频率需要额外 8.39 美元。

结论

较新的 AED 具有相对更好的疗效，但与传统 AED 相比并不显着。然而，使用更新的 AED，每单位改进的额外成本相当高，因此需要在癫痫治疗中考虑药物经济学。