title: Cost-effectiveness of add-on lamotrigine therapy in clinical practice.
abstract: OBJECTIVE
  This retrospective study addresses the cost-effectiveness of add-on therapy with lamotrigine in clinical practice.
  
  
  METHODS
  Two years' observational data of 165 patients were used. Seizure frequency, adverse effects and direct medical costs were recorded for the year before and the year after the start of lamotrigine add-on therapy. Therapy effectiveness was measured by: (1) reduction in seizure frequency and (2) retention time. The incremental cost-effectiveness ratio expressed the direct medical cost per patient treated effectively with lamotrigine.
  
  
  RESULTS
  The cost of medication was 492 (95% CI: 399-583) higher after the start of lamotrigine therapy. The extra cost of lamotrigine therapy (622) was partly offset by a reduction of the cost of co-medication (-130; 95% CI: -210 to -50). Overall, the total medical cost was 453 higher in the first year of lamotrigine therapy than in the year before the start of lamotrigine. Lamotrigine was effective in 47% of all the patients, making the resultant incremental cost-effectiveness ratio 954 per year.
  
  
  CONCLUSIONS
  Add-on therapy of lamotrigine for patients with uncontrolled epilepsy offers improved health outcomes. Lamotrigine therapy is associated with increased cost (453) and an annual incremental cost-effectiveness ratio of 954. These data, together with utility data published in the literature, support the notion that lamotrigine should be considered as an add-on therapy in for patients with refractory epilepsy.
authors.affiliation: Department of Clinical Pharmacy, University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. p.knoester@erasmusmc.nl
authors.forename: P D
authors.initials: PD
authors.lastname: Knoester
authors.forename: A J
authors.initials: AJ
authors.lastname: Boendermaker
authors.forename: A C G
authors.initials: AC
authors.lastname: Egberts
authors.forename: Y A
authors.initials: YA
authors.lastname: Hekster
authors.forename: A
authors.initials: A
authors.lastname: Keyser
authors.forename: J L
authors.initials: JL
authors.lastname: Severens
authors.forename: W O
authors.initials: WO
authors.lastname: Renier
authors.forename: C L P
authors.initials: CL
authors.lastname: Deckers
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004359:Drug Therapy, Combination; D004827:Epilepsy / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014227:Triazines / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine