Department of Economics, Lund University, Lund, Sweden.
Pharmacoeconomics. 2012 Oct 1;30(10):903-23. doi: 10.2165/11597110-000000000-00000.
Epilepsy is one of the most common neurological disorders, affecting more than 3 million people in Europe. This paper reviews the published evidence regarding the cost effectiveness of second-generation antiepileptic drugs (AEDs).
A systematic literature search was performed, using the databases Academic Search Complete, Econlit, EMBASE and MEDLINE. Health economic evaluations of newer (second-generation) AEDs, published as full-length journal articles, were searched for. We focused on evaluations of newer AEDs as treatment for partial-onset seizures. 470 studies were initially identified and 19 were finally included. Information regarding (i) AEDs studied, (ii) cost effectiveness, and (iii) a variety of health economic modelling specifics was extracted from each study. Then, the included studies were summarized and a quality assessment was performed, according to the British Medical Journal's guidelines for economic studies.
The results were as follows: (i) the cost per additional QALY for newer AEDs used as adjunctive treatment, compared with standard therapy, ranged between $US19 139 (levetiracetam) and $US57 210 (pregabalin) [year 2010 values]; no cost-effectiveness evidence was identified for felbamate, eslicarbazepine, oxcarbazepine or tiagabine; and (ii) all studies met at least 60% of the British Medical Journal's guidelines criteria, and seven studies were found to satisfy more than 80% of the criteria. Guidelines criteria not met involve inadequate reporting of input data and modelling details, including validation and availability of models used for cost-effectiveness calculations.
Although failure to meet good practice guidelines influences the reliability of the presented evidence adversely, a sufficient number of the included studies were found to comply enough with the guidelines in order for the qualitative content of the cost-effectiveness results - that some of the newer AEDs are cost effective - to be reliable. In fact, this conclusion is likely to be relatively robust, since the effect of improved seizure control on labour market performance was not included in the base-case results in any of the included studies and improved seizure control need only to have a moderate effect on sickness absenteeism in order for the corresponding treatment to be cost effective even when willingness to pay for an additional QALY is low. However, the cost effectiveness of newer AEDs has only been studied for a small number of settings, and hence future studies incorporating additional settings are needed.
癫痫是最常见的神经障碍之一，影响欧洲 300 多万人。本文综述了第二代抗癫痫药物（AED）成本效益的已有研究证据。
使用 Academic Search Complete、Econlit、EMBASE 和 MEDLINE 数据库进行系统文献检索，查找已发表的关于新型（第二代）AED 成本效益的完整期刊文章。我们重点关注新型 AED 作为部分发作性癫痫治疗的评估。最初确定了 470 项研究，最终纳入了 19 项研究。从每项研究中提取有关（i）研究的 AED、（ii）成本效益和（iii）各种健康经济模型具体信息。然后，根据英国医学杂志经济研究指南对纳入的研究进行总结和质量评估。
结果如下：（i）与标准治疗相比，新型 AED 作为辅助治疗的增量成本效益比，每增加一个质量调整生命年（QALY）的成本范围为 19139 美元（左乙拉西坦）至 57210 美元（普瑞巴林）[2010 年美元价值]；未发现 Felbamate、eslicarbazepine、oxcarbazepine 或 tiagabine 的成本效益证据；（ii）所有研究均至少符合英国医学杂志指南标准的 60%，有 7 项研究符合超过 80%的标准。未满足的指南标准涉及输入数据和模型细节报告不充分，包括用于成本效益计算的模型的验证和可用性。
尽管不符合良好实践指南会对所提供证据的可靠性产生不利影响，但纳入的研究中足够数量的研究符合指南标准，从而使成本效益结果的定性内容（即某些新型 AED 具有成本效益）具有可靠性。事实上，由于纳入研究的基础情况分析结果中均未包括癫痫控制改善对劳动力市场表现的影响，且只要癫痫控制改善对缺勤病假的影响仅为中度，相应的治疗就具有成本效益，即使支付额外 QALY 的意愿较低，因此该结论可能具有较强的稳健性。然而，新型 AED 的成本效益仅在少数情况下进行了研究，因此需要纳入更多设置的未来研究。
