COST-EFFECTIVENESS ANALYSIS (CEA) OF ANTIEPILEPTIC DRUG (AED) TREATMENT IN NEWLY DIAGNOSED PATIENTS WITH EPILEPSY: FINDINGS FROM A TERTIARY CARE HOSPITAL IN INDIA
Dr. Ranjana G., Dr. Kulkarni Chanda*, Dr. Sunita Nair and Dr. Sarma G. R. K.
Objective: To compare cost-effectiveness between newer vs older anti-epileptic drug (AED) treatment in patients with newly diagnosed epilepsy. Material and Methods: The socio-demographic data of patients with epilepsy (PWE), clinical characteristics and cost components were collected prospectively for 12 months. A decision analysis was carried out to compare cost-effectiveness of treatment strategies between older and newer AEDs with clobazam as add-on. We considered two outcome groups namely the complete success and the failure of seizure control. Results: There were 76 (43 males and 33 females) newly diagnosed PWE. Their median age at AED treatment initiation was 23 years (18-46 IQR 19-30) and 35(46%) were from lower/upper lower socioeconomic class. The probability of obtaining complete success varied from 73% with Carbamazepine (CBZ) - CBZ+CLB to 84% with Topiramate (TPM)-TPM+ Clobazam (CLB). Treatment strategy (CBZ) - CBZ+CLB) which recorded lowest cost was considered as reference cost. The expected annual total cost (direct + indirect cost) of treatment per patient during the first year were US$ 416.85; the total direct costs were US$351.45 and AED costs were US$26.17. The TPM-TPM+CLB was a non-dominated strategy, with ICER US$764.98 for total costs relative to CBZ-CBZ+CLB per additional patient with complete success. The AEDs for PHT, VPA, OXC, and LEV alone, and with CLB as add on were dominated (more costly, but less effective). ICER values with highest direct and total treatment cost estimates using one-way sensitivity analysis for CBZ and TPM were found to be non-dominated compared to least costly strategy PHT. However, the ICER value was not found to be cost-effective compared to WHO thresholds. Conclusion: The use of newer AED TPM alone and followed by CLB as add on strategy was found to be cost-effective compared to CBZ alone followed by CLB which is justified considering the GDP per capita.
Keywords: epilepsy, antiepileptic drugs (AEDs), patients with epilepsy (PWE), cost-effectiveness analysis (CEA), and decision tree model.
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