NEWER DRUGS FOR EPILEPSY
Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation
BackgroundA number of drug therapies are licensed for the treatment of epilepsy in adults, although many are limited to specific types of epilepsy and therapy regimens. However, at present, there does not appear to be a uniform approach to the selection or sequence of antiepileptic drug therapy. This review examined the clinical effectiveness, tolerability and cost-effectiveness of gabapentin, lamotrigine, levetiracetam, oxcarbazepine, tiagabine, topiramate and vigabatrin for epilepsy in adults.
There was little good-quality evidence from clinical trials to support the use of newer monotherapy or adjunctive therapy of antiepileptic drug therapies over older drugs, or to support the use of one newer antiepileptic drug therapy in preference to another. In general, data relating to clinical effectiveness, safety and tolerability failed to demonstrate consistent and statistically significant differences between the drugs.
The newer antiepileptic drug therapies may be cost-effective for the treatment of patients who have experienced adverse events with older antiepileptic drug therapies, who have failed to respond to the older drugs, or where such drugs are contraindicated. The integrated economic analysis also suggested that newer antiepileptic drug therapies used as adjunctive therapy may be cost-effective compared with the continuing current treatment alone.Conducted by: J Wilby1, A Kainth1, N Hawkins2, D Epstein2, H McIntosh1, C McDaid1, A Mason2, S Golder1, S O'Meara1, M Sculpher2, M Drummond2, C Forbes1
1. Centre for Reviews and Dissemination; 2. Centre for Health Economics
Further detailsProject page on HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal 76: The clinical effectiveness and cost effectiveness of newer drugs for epilepsy in adults. London: National Institute for Clinical Excellence; 2004
Wilby J, Kainth A, Hawkins N, Epstein D, McIntosh H, McDaid C, Mason A, Golder S, O'Meara S, Sculpher M, Drummond M, Forbes C. A rapid and systematic review of the clinical effectiveness, tolerability and cost effectiveness of newer drugs for epilepsy in adults. Health Technol Assess. 2005;9(15):1-172
Golder S, McIntosh HM, Duffy S, Glanville J . Developing efficient search strategies to identify reports of adverse effects in MEDLINE and EMBASE. Health Info Libr J. 2006;23(1):3-12
Hawkins N, Epstein D, Drummond M, Wilby J, Kainth A, Chadwick D, Sculpher M. Assessing the cost-effectiveness of new pharmaceuticals in epilepsy in adults: the results of a probabilistic decision model. Med Decis Making. 2005;25(5):493-510McIntosh HM, Woolacott NF, Bagnall AM. Assessing harmful effects in systematic reviews. BMC Med Res Methodol. 2004;4(19):1-6
Golder S, McIntosh HM, Duffy S, Glanville J. Developing efficient search strategies to identify papers on adverse events. HTAi Annual Meeting 2004. Krakow, Poland, 30 May 2004Kainth A, Wilby J, McIntosh HM, McDaid C, Forbes C. Newer drugs for epilepsy in adults: how good are the trials from a systematic review? HTAi Annual Meeting 2004. HTAi Annual Meeting 2004. Krakow, Poland, 30 May 2004
Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process