Health care cost associated with the use of enzyme-inducing and non-enzyme-active antiepileptic drugs in the UK: a long-term retrospective matched cohort study.
BACKGROUND
Some antiepileptic drugs (AEDs) induce expression of hepatic enzymes. This can contribute to comorbidities via interference with metabolic pathways and concomitant drug metabolization, thereby increasing the likelihood of health care interventions. Using medical records, we compared the direct health care cost in patients initiating epilepsy therapy with enzyme-inducing AEDs (EIAEDs) vs non-enzyme-active AEDs (nEAAEDs) over up to 12 years.


METHODS
Patients with untreated epilepsy were indexed in the UK Clinical Practice Research Datalink and Hospital Episode Statistics database when prescribed a new EIAED or nEAAED between January 2001 and December 2010. Propensity score matching reduced confounding factors between cohorts. Patients were followed until cohort treatment failure or data cut-off. The primary outcome was the median standardized monthly direct health care cost during follow-up in 2014 £GBP, calculated using published reference costs and compared using a Mann-Whitney U test.


RESULTS
The unmatched EIAED cohort (n = 2752) was older (54 vs 46 years), more likely to be male, had more comorbidities, and higher health care resource use/cost during the 1-year pre-index period (median £3014 vs £2516) than the nEAAED cohort (n = 2,137). The most common index EIAED and nEAAED were carbamazepine (63.3%) and lamotrigine (58.0%), respectively. After matching, cohorts had similar features (n = 951 each). Over up to 12 years of follow-up, the median standardized monthly direct health care cost was £229 for the EIAED and £188 for the nEAAED cohorts (p = 0.0091). The median cost was higher for the EIAED cohort in every year of follow-up. In the two cohorts, 25.1% and 20.1% of total mean cost during follow-up was epilepsy-related, with approximately 4.6% and 3.0% for AED acquisition, respectively. The median time to cohort treatment failure was shorter in the matched EIAED cohort (468 vs 1194 days).


CONCLUSIONS
Patients in the UK who initiated epilepsy therapy with an EIAED appeared to be at higher risk of complications associated with enzyme induction. In long-term matched cohort analyses, the median total direct health care cost associated with EIAED therapy was higher than with nEAAEDs. Changing current treatment practices could potentially improve patient outcomes and reduce costs.
UCB Pharma, Slough, UK. simon.borghs@ucb.com.
Simon
S
Borghs
UCB Pharma, Brussels, Belgium.
Solène
S
Thieffry
UCB Pharma, Monheim Am Rhein, Germany.
Matthias
M
Noack-Rink
UCB Pharma, Brussels, Belgium.
Peter
P
Dedeken
Redsen Limited, Bournemouth, UK.
Lai San
LS
Hong
UCB Pharma, Slough, UK.
Laura
L
Byram
Stats4Pharma, Cork, Ireland.
John
J
Logan
UCB Pharma, Slough, UK.
Jane
J
Chan
FV & JK Consulting Ltd., Guildford, UK.
Victor
V
Kiri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D065701:Cytochrome P-450 CYP3A Inducers / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D064420:Drug-Related Side Effects and Adverse Reactions / Q000191:economics*; D004827:Epilepsy / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D057216:Propensity Score; D012189:Retrospective Studies; D017211:Treatment Failure; D006113:United Kingdom; D055815:Young Adult
D000927:Anticonvulsants; D065701:Cytochrome P-450 CYP3A Inducers
Comorbidity; Cytochrome P450 enzyme system; Database; Drug-related side effects and adverse reactions; Epilepsy; Health care costs; Hospital records