PMID- 33132717 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220418 IS - 1319-0164 (Print) IS - 2213-7475 (Electronic) IS - 1319-0164 (Linking) VI - 28 IP - 10 DP - 2020 Oct TI - Need for pharmacoeconomic consideration of antiepileptic drugs monotherapy treatment in persons with epilepsy. PG - 1228-1237 LID - 10.1016/j.jsps.2020.08.013 [doi] AB - OBJECTIVE: Newer antiepileptic drugs (AEDs) are expected to have less adverse effects (AEs) and drug interactions as compared to conventional AEDs but the high cost is the major limitation for their use. This study evaluated variation in the cost of treatment with newer and conventional AEDs through its correlation with treatment efficacy and AEs in persons with epilepsy (PWE). METHODS: This cross-sectional study included PWE (28.9 +/- 9.9 years) having focal and generalized seizures on conventional [valproate, carbamazepine, phenytoin] or newer AEDs [levetiracetam, oxcarbazepine] for >6 months. Seizure frequency during the study (6 months) was compared to that within 6 months before the study. Other parameters assessed were Quality of life in epilepsy, Pittsburgh Sleep Quality Index, Gastrointestinal Quality of life Index, and Liverpool AEs Profile. The cost of treatment was determined as direct, indirect, and intangible costs. The incremental cost-effectiveness ratio (ICER) analysis was also performed. RESULTS: Out of 214 PWE, 51.4% were on newer AEDs. Newer and conventional AEDs did not differ significantly in seizure frequency reduction (60.29 vs. 53.09%), quality of life parameters, though these were improved significantly during the study period. The direct medical cost and total cost of treatment were lesser with conventional AEDs (p < 0.001 in both) than newer AEDs, but the intangible cost did not differ. The total cost of treatment was significantly influenced by factors (as per regression analysis) including the type of AEDs (significant difference between valproate, carbamazepine, and levetiracetam), frequency of seizures, cost of medicine (70.34% of total cost), hospital admission, and treatment of AEs. As per ICER, newer AEDs need an additional USD 8.39 per unit reduction in seizure frequency. CONCLUSION: Newer AEDs have comparatively better efficacy, though not significant than conventional AEDs. However, the additional cost per unit improvement is quite high with newer AEDs, necessitating pharmacoeconomic consideration in epilepsy treatment. CI - (c) 2020 Published by Elsevier B.V. on behalf of King Saud University. FAU - Sarangi, Sudhir C AU - Sarangi SC AD - Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. FAU - Kaur, Nivendeep AU - Kaur N AD - Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. FAU - Tripathi, Manjari AU - Tripathi M AD - Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. LA - eng PT - Journal Article DEP - 20200821 PL - Saudi Arabia TA - Saudi Pharm J JT - Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society JID - 9705695 PMC - PMC7584808 OTO - NOTNLM OT - Antiepileptic drug OT - Cost of treatment OT - Pharmacoeconomic OT - Quality of life OT - Seizure frequency COIS- The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. EDAT- 2020/11/03 06:00 MHDA- 2020/11/03 06:01 PMCR- 2020/08/21 CRDT- 2020/11/02 06:13 PHST- 2020/02/11 00:00 [received] PHST- 2020/08/18 00:00 [accepted] PHST- 2020/11/02 06:13 [entrez] PHST- 2020/11/03 06:00 [pubmed] PHST- 2020/11/03 06:01 [medline] PHST- 2020/08/21 00:00 [pmc-release] AID - S1319-0164(20)30193-6 [pii] AID - 10.1016/j.jsps.2020.08.013 [doi] PST - ppublish SO - Saudi Pharm J. 2020 Oct;28(10):1228-1237. doi: 10.1016/j.jsps.2020.08.013. Epub 2020 Aug 21.