A systematic review of economic evaluations of treatments for patients with epilepsy

Ben F. M. Wijnen*, Ghislaine A. P. G. van Mastrigt, Silvia M. A. A. Evers, Olga Gershuni, Danielle A. J. E. Lambrechts, Marian H. J. M. Majoie, Debby Postulart, Bert A. P. Aldenkamp, Reina J. A. de Kinderen

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

24 Citations (Web of Science)

Abstract

The increasing number of treatment options and the high costs associated with epilepsy have fostered the development of economic evaluations in epilepsy. It is important to examine the availability and quality of these economic evaluations and to identify potential research gaps. As well as looking at both pharmacologic (antiepileptic drugs [AEDs]) and nonpharmacologic (e.g., epilepsy surgery, ketogenic diet, vagus nerve stimulation) therapies, this review examines the methodologic quality of the full economic evaluations included. Literature search was performed in MEDLINE, EMBASE, NHS Economic Evaluation Database (NHS EED), Econlit, Web of Science, and CEA Registry. In addition, Cochrane Reviews, Cochrane DARE and Cochrane Health Technology Assessment Databases were used. To identify relevant studies, predefined clinical search strategies were combined with a search filter designed to identify health economic studies. Specific search strategies were devised for the following topics: (1) AEDs, (2) patients with cognitive deficits, (3) elderly patients, (4) epilepsy surgery, (5) ketogenic diet, (6) vagus nerve stimulation, and (7) treatment of (non)convulsive status epilepticus. A total of 40 publications were included in this review, 29 (73%) of which were articles about pharmacologic interventions. Mean quality score of all articles on the Consensus Health Economic Criteria (CHEC)-extended was 81.8%, the lowest quality score being 21.05%, whereas five studies had a score of 100%. Looking at the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), the average quality score was 77.0%, the lowest being 22.7%, and four studies rated as 100%. There was a substantial difference in methodology in all included articles, which hampered the attempt to combine information meaningfully. Overall, the methodologic quality was acceptable; however, some studies performed significantly worse than others. The heterogeneity between the studies stresses the need to define a reference case (e.g., how should an economic evaluation within epilepsy be performed) and to derive consensus on what constitutes standard optimal care.

Original languageEnglish
Pages (from-to)706-726
Number of pages21
JournalEpilepsia
Volume58
Issue number5
DOIs
Publication statusPublished - May 2017

Keywords

  • Epilepsy
  • Economic evaluations
  • Pharmacologic interventions
  • Nonpharmacologic interventions
  • Study quality
  • VAGUS NERVE-STIMULATION
  • LENNOX-GASTAUT-SYNDROME
  • REFRACTORY PARTIAL EPILEPSY
  • DRUG-RESISTANT EPILEPSY
  • PARTIAL-ONSET SEIZURES
  • ADD-ON THERAPY
  • COST-EFFECTIVENESS
  • ADJUNCTIVE TREATMENT
  • ANTIEPILEPTIC DRUGS
  • CLINICAL-OUTCOMES

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