KU Leuven, Leuven, Belgium.
CNS Drugs. 2012 Apr 1;26(4):337-50. doi: 10.2165/11599240-000000000-00000.
Lacosamide is an anti-epileptic drug, indicated as adjunctive therapy for patients with focal seizures with or without secondary generalization. This study aims to assess the cost effectiveness of standard anti-epileptic drug therapy plus lacosamide 300 mg/day compared with standard therapy alone from the perspective of the Belgian healthcare payer.
The treatment pathway of a hypothetical cohort of 1000 patients over 2 years was simulated using a decision tree. Data about health state probabilities, seizure frequency and utility values were taken from lacosamide trials or from the literature. Effectiveness measures included the number of seizures avoided and the number of quality-adjusted life-years gained. Unit costs were taken from national references. Resource use was estimated by a panel of eight neurologists with extensive experience in epilepsy. The price year was 2008. Deterministic and probabilistic sensitivity analyses were conducted.
Over a 24-month period, standard anti-epileptic drug therapy plus lacosamide led to a reduction of seven seizures, an increase of 0.038 quality-adjusted life-years and a cost decrease of &U20AC;3619 per patient compared with standard therapy alone. Using a willingness to pay of &U20AC;30 000 per quality-adjusted life-year, the net monetary benefit of standard anti-epileptic drug therapy plus lacosamide amounted to &U20AC;4754. The probability of standard anti-epileptic drug therapy plus lacosamide being cost effective was 97.3%, 99.8%, 99.9% and 100% at 6, 12 , 18 and 24 months, respectively.
In patients with difficult-to-treat epilepsy, standard anti-epileptic drug therapy plus lacosamide appears to be a cost-effective option in Belgium.
拉科酰胺是一种抗癫痫药物，适用于伴有或不伴有继发全面性发作的局灶性发作患者的辅助治疗。本研究旨在从比利时医疗保健支付者的角度评估标准抗癫痫药物治疗加拉科酰胺 300mg/天与单纯标准治疗相比的成本效果。
使用决策树模拟了一个假设的 1000 名患者队列在 2 年内的治疗途径。健康状态概率、癫痫发作频率和效用值的数据来自拉科酰胺试验或文献。有效性指标包括避免的癫痫发作次数和获得的质量调整生命年数。单位成本取自国家参考资料。资源利用由 8 位具有丰富癫痫治疗经验的神经病学家小组进行估计。价格年份为 2008 年。进行了确定性和概率敏感性分析。
在 24 个月的时间内，与单纯标准治疗相比，标准抗癫痫药物治疗加拉科酰胺可减少 7 次癫痫发作，增加 0.038 个质量调整生命年，并降低每位患者 3619 欧元的成本。在愿意支付 30000 欧元/QALY 的情况下，标准抗癫痫药物治疗加拉科酰胺的净货币效益为 4754 欧元。标准抗癫痫药物治疗加拉科酰胺的成本效益在 6、12、18 和 24 个月时分别为 97.3%、99.8%、99.9%和 100%。
在治疗困难的癫痫患者中，标准抗癫痫药物治疗加拉科酰胺似乎是比利时一种具有成本效益的选择。
