Cost minimization analysis of monotherapy for antiepileptic treatment in patients with newly diagnosed epilepsy: The position in Spain

Objective. To analyze the cost of monotherapeutic treatment of patients with newly diagnosed Epilepsy. Patients and methods. We analysed the cost of treatment with lamotrigine (LTG), carbamazepine (CBZ), phenytoin (PHT) and valproic acid (VPA) using published data regarding the efficacy and tolerability of comparative clinical trials of monotherapy. We established a model of treatment for newly diagnosed patients during the first 12 months after diagnosis. A panel of doctors reached a consensus on the we of resources, costs and model of treatment in Spain. We made a cost minimization analysis for economic assessment of the data based on the fact that randomised trials indicated that CBZ, LTG, PHT and VPA were of similar efficacy. Analysis was done as 'intention to treat'. Only direct medical costs were considered. Results. In Spain treatment with LTG is twice or three times as expensive as treatment with the other drugs. Sensitivity analysis showed that variations in the interval of use of resources and of costs (defined by the panel of doctors) did riot significantly alter the results. Conclusions. Treatment with LTG is more expensive than treatment with the classical drugs. In view of the methodological limitations of this study, further analysis is necessary, particularly of the methodology of cost-benefit, to evaluate the economic impact of the new antiepileptic drugs and determine whether their use is justified as drugs of first choice.