COST-EFFECTIVENESS MODEL OF ADJUNCTIVE LAMOTRIGINE FOR THE TREATMENT OF EPILEPSY

Objective: To predict the cost-effectiveness of lamotrigine by evaluat ing the costs and health outcomes in treated patients. Background: Lam otrigine adjunctive therapy has been found to be associated with decre ased seizure frequency and severity in patients who are refractory to treatment with the older antiepileptic drugs (AEDs). Methods: We used a cost-effectiveness clinical decision analysis framework to assess th e impact of these clinical benefits on patient health care use. The me asure of effectiveness was seizure-free days gained. The measures of h ealth care resource use included hospitalizations, outpatient and emer gency department visits, surgery, and AEDs. Medical care use and cost estimates were derived from clinical trial data and published sources. Costs and effectiveness (incremental costs per seizure-free days gain ed) of lamotrigine adjunctive therapy versus older AEDs were compared in patients refractory to previous treatment during three time periods : the start-up year, the second year when decisions about surgery were made, and all subsequent years. Results and conclusions: The model pr edicts that use of lamotrigine would be associated with an overall red uction in use of other direct medical care resources (hospitalizations , outpatient visits, diagnostic and laboratory tests, and surgery). Fo r a 10-year time horizon, the estimated cost-effectiveness ratio is $6 .9 per seizure-free day gained. The model provides a flexible framewor k to analyze the effect of new antiepileptic drugs.