Cost minimization analysis of antiepileptic drugs in newly diagnosed epilepsy in 12 European countries

A recent United Kingdom cost minimization analysis (CMA) of four antiepilep tic drugs (AEDs) used to treat newly diagnosed adult epilepsy demonstrated that a new drug, lamotrigine (LTG), incurred higher costs than carbamazepin e (CBZ), phenytoin (PHT), and valproate (VPA), whose costs were similar. Th is analysis took account of each drug's side effect and tolerability profil e. The present analysis investigated the costs of treatment with LTG, CBZ, PI-IT, and VPA in 12 European countries. Data were derived from published s ources and from a panel of locally based experts. When no published data we re available, estimates were obtained using expert opinion by a consensus m ethod. These data were incorporated into a treatment pathway model, which c onsidered the treatment of patients during the first 12 months after diagno sis. The primary outcome considered was seizure freedom. Randomized control led trials demonstrate that the drugs considered are equally effective in t erms of their ability to achieve seizure freedom, and thus the most appropr iate form of economic evaluation is a CMA. These trials provided data on th e incidence of side effects, dosages, and retention rates. The economic per spective taken was that of society as a whole and the analysis was calculat ed on an "intent-to-treat" basis. Only direct medical costs were considered . In each country considered, LTG was twofold to threefold more expensive t han the other drugs considered. A sensitivity analysis demonstrated that va rying each of the assumptions (range defined by expert panels) did not sign ificantly alter the results obtained.