Heaney, Dominic Connell; (2002) Anti-epileptic drugs: Economic considerations in clinical practice. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Doctors are under constant pressure to prescribe new drugs but when treating epilepsy, the advantages such drugs offer are small in terms of improved efficacy, tolerability and side-effect profiles. Ultimately, all drugs are prescribed from limited financial budgets and doctors are being forced to recognise the importance of economic factors in their clinical practice. Four broad research questions were addressed: how best to value epilepsy treatments in financial terms; the importance of national factors in economic evaluations; how patients' views may be incorporated into economic analysis; and whether the benefits of new anti-epileptic drugs justify and outweigh their costs. The clinical situations investigated included the treatment of newly diagnosed epilepsy, refractory epilepsy and status epilepticus. Four introductory studies assessed the use of consensus panels, qualitative research techniques, international cost comparisons and cost-of-illness methods. A further four studies used economic modelling techniques and sensitivity analysis to assess the cost-effectiveness of new anti-epileptic drugs. Finally, contingent valuation was assessed as a means by which patient opinion could be incorporated into economic evaluation. In each study, by including all relevant costs and benefits, the importance of economic factors in clinical practice was made clear. This research has implications for (1) the way in which future economic evaluations are performed and (2) how economic factors should be considered in clinical practice. Consensus panels were demonstrated to be a reliable predictor of wider medical opinion. The statistical properties of economic data and the implications for sample size in future studies were shown. The notion that results of economic studies can be extrapolated from one country to another was demonstrated to be a fallacy. Several types of model were shown to be applicable in modelling the effects of epilepsy treatment. Conclusions about the cost-effectiveness of Lamotrigine in newly diagnosed focal-onset epilepsy, new anti-epileptic drugs in refractory epilepsy and Fosphenytoin in status-epilepticus were reached. A significant conclusion relates to the role of patient opinion in economic evaluation. Contingent valuation allows patient opinion to be used to value a wide range of indirect and intangible costs. Combined with costs from the perspective of the UK National Health Service, the inclusion of patient opinion allows the widest possible range of economic factors to be considered in clinical practice.

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