Cost-effectiveness of first-line antiepileptic drug treatments in the developing world: a population-level analysis

To establish the population-level costs and cost-effectiveness of first-line antiepileptic drug (AED) treatments for reducing the treatment gap in developing countries.

A population model was applied to nine World Health Organization (WHO) developing subregions to estimate the impact of four first-line AEDs in the primary care management of (ICD-10 defined) idiopathic epilepsy and epileptic syndromes: phenobarbitone (PB), phenytoin (PHT), carbamazepine (CBZ), and valproic acid (VPA). The efficacy of treatment was gauged in terms of improvements to both disability and recovery, subsequently adjusted for treatment coverage, response, and adherence. Total population-level treatment effects (measured in disability-adjusted life years or DALYs averted) and treatment costs (measured in international dollars; IUS dollars) were combined to form ratios of cost-effectiveness.

Across nine developing WHO subregions, extending AED treatment coverage to 50% of primary epilepsy cases would avert between 150 and 650 DALYs per one million population (equivalent to 13-40% of the current burden), at an annual cost per capita of IUS dollars 0.20-1.33. Older first-line AEDs (PB, PHT) were most cost-effective on account of their similar efficacy but lower acquisition cost (IUS dollars 800-2,000 for each DALY averted).

A significant proportion of the current burden of epilepsy in developing countries is avertable by scaling-up the routine availability of low-cost AEDs. Critical factors in the successful implementation of such a scaled-up level of service delivery, apart from renewed political support and investment, relate to appropriate training and continuity of drug supply.