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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Neurology 1/2017

Health care cost associated with the use of enzyme-inducing and non-enzyme–active antiepileptic drugs in the UK: a long-term retrospective matched cohort study

Zeitschrift:
BMC Neurology > Ausgabe 1/2017
Autoren:
Simon Borghs, Solène Thieffry, Matthias Noack-Rink, Peter Dedeken, Lai San Hong, Laura Byram, John Logan, Jane Chan, Victor Kiri
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12883-017-0837-y) contains supplementary material, which is available to authorized users.

Abstract

Background

Some antiepileptic drugs (AEDs) induce expression of hepatic enzymes. This can contribute to comorbidities via interference with metabolic pathways and concomitant drug metabolization, thereby increasing the likelihood of health care interventions. Using medical records, we compared the direct health care cost in patients initiating epilepsy therapy with enzyme-inducing AEDs (EIAEDs) vs non-enzyme-active AEDs (nEAAEDs) over up to 12 years.

Methods

Patients with untreated epilepsy were indexed in the UK Clinical Practice Research Datalink and Hospital Episode Statistics database when prescribed a new EIAED or nEAAED between January 2001 and December 2010. Propensity score matching reduced confounding factors between cohorts. Patients were followed until cohort treatment failure or data cut-off. The primary outcome was the median standardized monthly direct health care cost during follow-up in 2014 £GBP, calculated using published reference costs and compared using a Mann–Whitney U test.

Results

The unmatched EIAED cohort (n = 2752) was older (54 vs 46 years), more likely to be male, had more comorbidities, and higher health care resource use/cost during the 1-year pre-index period (median £3014 vs £2516) than the nEAAED cohort (n = 2,137). The most common index EIAED and nEAAED were carbamazepine (63.3%) and lamotrigine (58.0%), respectively. After matching, cohorts had similar features (n = 951 each). Over up to 12 years of follow-up, the median standardized monthly direct health care cost was £229 for the EIAED and £188 for the nEAAED cohorts (p = 0.0091). The median cost was higher for the EIAED cohort in every year of follow-up. In the two cohorts, 25.1% and 20.1% of total mean cost during follow-up was epilepsy-related, with approximately 4.6% and 3.0% for AED acquisition, respectively. The median time to cohort treatment failure was shorter in the matched EIAED cohort (468 vs 1194 days).

Conclusions

Patients in the UK who initiated epilepsy therapy with an EIAED appeared to be at higher risk of complications associated with enzyme induction. In long-term matched cohort analyses, the median total direct health care cost associated with EIAED therapy was higher than with nEAAEDs. Changing current treatment practices could potentially improve patient outcomes and reduce costs.
Zusatzmaterial
Additional file 1: Further details on the calculation of health care resource use and costs. Table S1. Variables on which the cohorts were significantly different at baseline. Table S2. Most common incident diagnoses during the post-index period. (DOCX 26 kb)
12883_2017_837_MOESM1_ESM.docx
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