Skip to main content

Advertisement

Log in

A Markov model of treatment of newly diagnosed epilepsy in the UK

An initial assessment of cost-effectiveness of topiramate

  • Original Papers
  • Published:
The European Journal of Health Economics, formerly: HEPAC Aims and scope Submit manuscript

Abstract

Long-term comparative trials among newer antiepileptic drugs are lacking; therefore decision models are needed to guide treatment decisions. The goal of this study was to develop an economic model of newly diagnosed epilepsy in the UK and to provide the first assessment of topiramate. A Markov model was developed combining data from clinical trials, cost-of illness, mortality, and utility studies. Expected costs and utilities associated with treatment strategies (first- and second-line treatments) were compared to find the cost-effectiveness frontier. First- and second-line monotherapy with topiramate or carbamazepine in partial seizures was less costly and more effective than other scenarios. In generalised seizures first-line topiramate was cost-effective with valproate or lamotrigine as second-line treatments depending on the set of utilities used. Models provide a relevant framework within which costs and health gains of antiepileptic drugs treatment options can be studied. Our findings are further evidence of the promising role of topiramate for patients with newly diagnosed epilepsy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1.
Fig. 2.
Fig. 3.

Similar content being viewed by others

References

  1. Anonymous (2002) Health technology appraisal scope document. Newer drugs for adults with epilepsy. National Institute for Clinical Excellence–

  2. Wallace H, Shorvon S, Tallis R (1998) Age-specific incidence and prevalence rates of treated epilepsy in an unselected population of 2:052:922 and age-specific fertility rates of women with epilepsy. Lancet 352:1970–1973

    Article  CAS  PubMed  Google Scholar 

  3. Shorvon S (1999) Services for patients with epilepsy. Report of a Clinical Standards Advisory Group committee chaired by A. Kitson. Stationary Office: London

    Google Scholar 

  4. Hanna NJ, Black M, Sander JW, Smithson WH, Appleton R, Brown S, Fish DR (2002) The National Sentinel Clinical audit of epilepsy-related death: epilepsy-death in the shadows. Stationary Office: London

    Google Scholar 

  5. Berg AT, Shinnar S, Levy SR, Testa FM, Smith-Rapaport S, Beckerman B (2000) How well can epilepsy syndromes be identified at diagnosis? A reassessment 2 years after initial diagnosis. Epilepsia 41:1269–1275

    CAS  PubMed  Google Scholar 

  6. Manford M, Hart YM, Sander JW, Shorvon SD (1992) The National General Practice Study of Epilepsy. The syndromic classification of the International League Against Epilepsy applied to epilepsy in a general population. Arch Neurol 49:801–808

    CAS  PubMed  Google Scholar 

  7. Shank RP, Gardocki JF, Streeter AJ, Maryanoff BE (2000) An overview of the preclinical aspects of topiramate: pharmacology, pharmacokinetics, and mechanism of action. Epilepsia 41 [Suppl 1]:S3–S9

  8. North West Clinical Neuroscience Partnership (NHS) (2001) The management of adults with epilepsy. A North West Clinical Framework

  9. Selai C, Trimble M, Kaiser S, Price M (2002) New anti-epileptic drugs: clinical outcomes and utility scores. Poster P330 at 5th European Congress on Epileptology, 6–10 October, Madrid

  10. Craig BA, Sendi PP (2002) Estimation of the transition matrix of discrete-time Markov chain. Health Econ 11:33–42

    Article  PubMed  Google Scholar 

  11. Privitera MD, Brodie MJ, Mattson RH, Chadwick D, Neto W, Wang S, for the EPMN 105 Study Group (2003) Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand 107:165–175

    Article  CAS  PubMed  Google Scholar 

  12. Jacoby A, Buck D, Baker G, McNamee P, Graham-Jones S, Chadwick D (1998) Uptake and costs of care for epilepsy: findings from a UK regional study. Epilepsia 39:776–786

    CAS  PubMed  Google Scholar 

  13. Netten A, Rees T, Harrison G (eds), Personal Social Services Research Unit (2001) Unit costs of health and social care 2001. University of Kent at Canterbury: Canterbury

    Google Scholar 

  14. Begley CE, Annegers JF, Lairson DR, Reunolds TF, Hauser WA (1994) Cost of epilepsy in the United States: a model based on incidence and prognosis. Epilepsia 35:1230–1243

    CAS  PubMed  Google Scholar 

  15. Yuen P (ed) (2001) OHE compendium of health statistics, 13th edn. Office of Health Economics: London

    Google Scholar 

  16. Lhatoo SD, Johnson AL, Goodridge DM, MacDonald BK, Sander JWAS, Shrovon SD (2001) Mortality in epilepsy in the first 11 to 14 years after diagnoses: a multivariate analysis of a long-term, prospective, population-based cohort. Ann Neurol 49:336–344

    Article  CAS  PubMed  Google Scholar 

  17. Nilsson L, Farahmand BY, Persson P-G, Thiblin I, Tomson T (1999) Risk factors for sudden unexpected death in epilepsy: a case-control study. Lancet 353:888–893

    Article  CAS  PubMed  Google Scholar 

  18. Messenheimer J, Mullens EL, Giorgi L, Young F (1998) Safety review of adult clinical trial experience with lamotrigine. Drug Saf 18:281–296

    CAS  PubMed  Google Scholar 

  19. Hebert AA, Ralston JP (2001) Cutaneous reactions to anticonvulsant medications. J Clin Psychiatry 62 [Suppl 14]:22–26

    Google Scholar 

  20. Rosenfeld WE (1997) Topiramate: a review of preclinical, pharmacokinetic, and clinical data. Clin Ther 19:1294–1308

    Article  CAS  PubMed  Google Scholar 

  21. Fenwick E, Claxton K, Sculpher M (2001) Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 10:779–787

    Article  CAS  PubMed  Google Scholar 

  22. Towse A, Pritchard C, Devlin N (eds) (2002) Cost-effectiveness thresholds—economic and ethical issues. King's Fund and Office of Health Economics

  23. Weinstein MC (1990) Principles of cost-effective resource allocation in health care organisations. Int J Technol Assess Health Care 6:93–105

    CAS  PubMed  Google Scholar 

  24. Brodie MJ, Richens A, Yuen AWC, for the UK Lamotrigine/Carbamazepine Monotherapy Trial Group (1995) Double-blind comparison of lamotrigine and carbamazepine in newly diagnosed epilepsy. Lancet 345:476–479

    CAS  PubMed  Google Scholar 

  25. Anonymous (2001) British national formulary 42. British Medical Association and the Royal Pharmaceutical Society of Great Britain

  26. OMNILABS (UK) Limited (2000) Directory and price list

  27. Chartered Institute of Public Finance and Accountancy (2000) The health service financial database and comparative tool, 2000. Institute of Public Finance Limited: Croydon

    Google Scholar 

  28. Department of Health (2001) The new NHS-2001 reference costs.http://www.doh.gov.uk/nhsexec/refcosts.htm

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to E. Remák.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Remák, E., Hutton, J., Price, M. et al. A Markov model of treatment of newly diagnosed epilepsy in the UK. HEPAC 4, 271–278 (2003). https://doi.org/10.1007/s10198-003-0176-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-003-0176-3

Keywords

Navigation