Document Detail

Economic evaluation of anti-epileptic drug therapies with specific focus on teratogenic outcomes.
MedLine Citation:
PMID:  22494266     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Anti-epileptic drugs are known to be teratogenic, yet many women do need to continue the anti-epileptic drug use during pregnancy.
OBJECTIVES: To perform an economic evaluation of the anti-epileptic drug choice in young women who potentially wish to become pregnant. In particular, to estimate the impact of teratogenicity on the costs per quality adjusted life year (QALY).
METHODS: A decision-tree model is used to calculate the costs per QALY, taking into account the malformation risk in offspring due to the exposure to carbamazepine, lamotrigine or valproic acid, based on the European birth cohort of 2007. Probabilistic sensitivity analyses were performed using Monte Carlo simulation.
RESULTS: Valproic acid is dominated by carbamazepine after rank ordering on costs. The incremental cost-effectiveness of lamotrigine vs carbamazepine was estimated at €175,534 per QALY. Although valproic acid was dominated by carbamazepine in terms of costs and related effects, it is clinically relevant to compare lamotrigine with valproic acid. In particular, treatment options are dependent on several individual and clinical characteristics and these agents are therefore not always considered as interchangeable for all specified populations. The incremental cost-effectiveness for lamotrigine vs valproic acid was estimated at €13,370 per QALY. With assuming a willingness to pay threshold of €50,000 per QALY, results from the probabilistic analysis resulted in an acceptance level for lamotrigine vs carbamazepine and lamotrigine vs valproic acid of 4% and 99%, respectively.
CONCLUSION: Based on epidemiological data it is advised to whenever possible avoid valproic acid during pregnancy. Both carbamazepine and lamotrigine are estimated to be cost-effective treatment options vs valproic acid if focused on teratogenicity.
Janneke Jentink; Cornelis Boersma; Lolkje T W de Jong-van den Berg; Maarten J Postma
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-05-03
Journal Detail:
Title:  Journal of medical economics     Volume:  15     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-13     Completed Date:  2013-01-14     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  England    
Other Details:
Languages:  eng     Pagination:  862-8     Citation Subset:  IM    
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MeSH Terms
Abnormalities, Drug-Induced / economics*
Anticonvulsants / adverse effects*,  economics
Carbamazepine / adverse effects*,  economics
Cost-Benefit Analysis
Epilepsy / drug therapy
Monte Carlo Method
Outcome Assessment (Health Care) / economics*
Pregnancy Complications / drug therapy,  psychology
Quality-Adjusted Life Years
Triazines / adverse effects*,  economics*
Valproic Acid / adverse effects*,  economics
Young Adult
Reg. No./Substance:
0/Anticonvulsants; 0/Triazines; 33CM23913M/Carbamazepine; 614OI1Z5WI/Valproic Acid; U3H27498KS/lamotrigine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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