title: A systematic review of economic evaluations of treatments for patients with epilepsy.
abstract: The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgery, ketogenic diet, vagus nerve stimulation) therapies, this review examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes "standard optimal care."
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Ben F M
authors.initials: BFM
authors.lastname: Wijnen
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Ghislaine A P G
authors.initials: GAPG
authors.lastname: van Mastrigt
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Silvia M A A
authors.initials: SMAA
authors.lastname: Evers
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.|Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Olga
authors.initials: O
authors.lastname: Gershuni
authors.affiliation: Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.|Department of Neurology, Academic Center for Epileptology, Epilepsy Center Kempenhaeghe & Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Danielle A J E
authors.initials: DAJE
authors.lastname: Lambrechts
authors.affiliation: Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.|Department of Neurology, Academic Center for Epileptology, Epilepsy Center Kempenhaeghe & Maastricht University Medical Center, Maastricht, The Netherlands.|MHENS School of Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.|School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
authors.forename: Marian H J M
authors.initials: MHJM
authors.lastname: Majoie
authors.affiliation: Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Debby
authors.initials: D
authors.lastname: Postulart
authors.affiliation: Department of Research & Development, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.|Department of Neurology, Academic Center for Epileptology, Epilepsy Center Kempenhaeghe & Maastricht University Medical Center, Maastricht, The Netherlands.|MHENS School of Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.|Department of Behavioral Sciences, Epilepsy Center Kempenhaeghe, Heeze, The Netherlands.
authors.forename: Bert A P
authors.initials: BAP
authors.lastname: Aldenkamp
authors.affiliation: Department of Health Services Research, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Reina J A
authors.initials: RJA
authors.lastname: de Kinderen
mesh_terms: D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002648:Child; D060825:Cognitive Dysfunction / Q000150:complications / Q000191:economics / Q000628:therapy; D003131:Combined Modality Therapy / Q000191:economics; D015897:Comorbidity; D003362:Cost-Benefit Analysis / Q000191:economics*; D055423:Diet, Ketogenic / Q000009:adverse effects / Q000191:economics; D000069279:Drug Resistant Epilepsy / Q000191:economics / Q000628:therapy; D004827:Epilepsy / Q000191:economics* / Q000628:therapy*; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D013226:Status Epilepticus / Q000191:economics / Q000628:therapy; D055536:Vagus Nerve Stimulation / Q000009:adverse effects / Q000191:economics
chemical_list: D000927:Anticonvulsants
keywords: Economic evaluations; Epilepsy; Nonpharmacologic interventions; Pharmacologic interventions; Study quality