Cost-effectiveness of carbamazepine in epilepsy

Carbamazepine is widely recommended as a first-line antiepileptic drug for new-onset partial seizures with or without generalization. Branded carbamazepine remains commonly prescribed. Newer antiepileptic drugs have higher acquisition costs than carbamazepine, but may offer advantages in terms of tolerability and side-effect profile that may offset their additional cost. Furthermore, generic carbamazepine is often cheaper than branded forms, and many argue for a policy of prescribing the cheapest available generic form. This study reviews the scant health economic data concerning the use of carbamazepine to treat epilepsy to establish whether use of this drug is cost effective. Carbamazepine would appear to be a cost-effective treatment for epilepsy in certain contexts, although evidence from a prospective, randomized, controlled trial is awaited and this assertion may not be true for certain patient subgroups, or in developing world health services. Furthermore, at this time there is insufficient evidence to support policies of cheapest generic or brand-only prescribing.