Department of economics, Lund University, Lund, Sweden.
Acta Neurol Scand. 2013 Jun;127(6):419-26. doi: 10.1111/ane.12077. Epub 2013 Jan 31.
To calculate comparative incremental cost-effectiveness ratios (cost per quality-adjusted life year, QALY) and net marginal benefits for retigabine as add-on treatment for patients with uncontrolled focal seizures as compared to add-on lacosamide treatment and no add-on treatment, respectively.
MATERIALS & METHODS: Calculations were performed using a validated decision-tree model. The study population consisted of adult patients with focal-onset epilepsy in published randomized placebo-controlled add-on trials of retigabine or lacosamide. Healthcare utilization and QALY for each treatment alternative were calculated. Probabilistic sensitivity analysis was performed using the specification of this model as a basis for Monte Carlo simulations. 2009 prices were used for all costs.
Results were reported for a 2-year follow-up period. Retigabine add-on treatment was both more effective and less costly than lacosamide add-on treatment, and the cost per additional QALY for the retigabine no add-on (standard) therapy comparison was estimated at 2009€ 15,753. Using a willingness-to-pay threshold for a QALY of € 50,000, the net marginal values were estimated at 2009€ 605,874 for retigabine vs lacosamide and 2009€ 2,114,203 for retigabine vs no add-on, per 1,000 patients. The probabilistic analyses showed that the likelihood that retigabine treatment is cost-effective is at least 70%.
The estimated cost per additional QALY, for the retigabine vs no add-on treatment comparison, is well within the range of newly published estimates of willingness to pay for an additional QALY. Thus, add-on retigabine treatment for people with focal-onset epilepsy with no/limited response to standard antiepileptic treatment appears to be cost-effective.
计算与添加治疗相比，作为附加治疗的瑞替加滨与添加治疗相比，添加拉科酰胺治疗和不添加治疗相比，分别为未控制的局灶性发作患者的增量成本效益比（每质量调整生命年的成本，QALY）和净边际效益。
使用经过验证的决策树模型进行计算。研究人群由发表的瑞替加滨或拉科酰胺的随机安慰剂对照附加试验中患有局灶性癫痫发作的成年患者组成。计算了每种治疗选择的医疗保健利用率和 QALY。使用该模型的规范作为蒙特卡罗模拟的基础进行概率敏感性分析。所有成本均使用 2009 年价格。
报告了为期 2 年的随访结果。与添加治疗相比，添加瑞替加滨治疗不仅更有效，而且成本更低，与添加瑞替加滨治疗相比，标准治疗的每增加一个 QALY 的成本估计为 2009 年的 20,000 欧元 15,753。使用愿意为每 QALY 支付 50,000 欧元的意愿支付阈值，估计瑞替加滨与拉科酰胺的净边际值为 2009 年的 20,000 欧元 605,874，与不添加瑞替加滨相比，2009 年为 20,000 欧元 2,114,203，每 1,000 名患者。概率分析表明，瑞替加滨治疗具有成本效益的可能性至少为 70%。
对于瑞替加滨与不添加治疗的比较，估计每增加一个 QALY 的额外成本在新公布的对额外 QALY 的支付意愿范围内。因此，对于对标准抗癫痫治疗无反应或反应有限的局灶性癫痫发作患者，添加瑞替加滨治疗似乎具有成本效益。
