Economic aspects of epilepsy and antiepileptic treatment: a review of the literature.
The recent literature on the economic aspects of epilepsy and antiepileptic treatment are systematically reviewed. Studies for this literature review were selected by conducting a Medline literature search from January 1998 to October 2004. Studies reviewed had to follow one of the standard methods of health economics evaluation (cost of illness, cost-minimization analysis, cost-effectiveness analysis, cost-benefit analysis and cost-utility analysis). A total of 31 epilepsy cost studies were reviewed. Cost-of-illness studies showed a marked difference in cost between countries and healthcare systems. Cost-minimization analysis evaluations of four drugs with equivalent clinical efficacy found lamotrigine to be the most costly and carbamazepine the most economic. Cost-effectiveness analysis studies found topiramate to be more cost effective than lamotrigine, and surgical lobectomy to be a very cost-effective treatment in the long term. Cost-benefit analysis studies generally focused on vagal nerve stimulation and epilepsy surgery, and found both treatment modalities to be significantly cost beneficial. Only two cost-utility analysis studies were performed and found long-term lamotrigine treatment to be less economically effective than most other pharmacologic treatments of serious disorders. Vagal nerve stimulation was found to be of questionable economic value and further research is necessary for clarification. The methodologic heterogeneity observed in the studies reviewed makes comparisons between them difficult. Nevertheless, many interesting interpretations arise from the results. Cost-effectiveness analysis studies were found to be much more credible than cost-minimization or cost-benefit analysis evaluations since they avoid efficacy of drugs being reduced to clinical efficacy parameters alone. Cost-utility analysis studies were found to be the most promising type of economic analysis since they are the only type of analysis that incorporates the patients' point of view. In conclusion, comparison across studies can only be achieved if future studies follow a common set of methods and similar economic-evaluation models. A collaborative effort of all experts involved is necessary if this is to be achieved.
Pillas
Demetris
D
Institute of Neurology, Queen Square, London, UK. d.pillas@ion.ucl.ac.uk
Selai
Caroline
C