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Trends in paediatric antiseizure-medication use and costs in France, 2014-2023: a nationwide population-based
Rima Nabbout1,2, Annaëlle Santilli3, Louise Tyvaert4,5
1Reference Centre for Rare Epilepies, Department of Paediatric Neurology, Necker Enfants Malades Hospital, APHP, Member of European Reference Network EpiCARE, Universite Paris Cité, 24 Boulevard du Montparnasse, 75015, Paris, France.
Insights
Paediatric anti-seizure medication use in France shifted towards newer drugs, but generic uptake remains low. Targeted strategies could save millions and fund new epilepsy treatments.
Area of Science:
- Neurology
- Pharmacology
- Public Health
Background:
- Epilepsy is a common childhood neurological disorder.
- French policies aim to improve anti-seizure medication (ASM) safety and affordability.
- The impact of these policies on pediatric ASM use is unknown.
Purpose of the Study:
- To analyze trends in pediatric ASM use, costs, generic uptake, and sex differences in France (2014-2023).
- To assess the effectiveness of current policies on pediatric epilepsy treatment.
Main Methods:
- Retrospective drug-utilization study using French National Health Data System (OpenMedic).
- Analysis of dispensing data for 24 ASMs in individuals under 18 years (2014-2023).
- Statistical analysis of temporal trends, sex differences, and determinants of generic dispensing.
Main Results:
- Over 2 million children used over 15 million ASM boxes, costing €274.4 million.
- Annual pediatric ASM users increased by 24%, with a rise in third-generation agents and a fall in first- and second-generation agents.
- Valproate use decreased significantly, while lamotrigine and levetiracetam use increased. Generic dispensing rose from 11.2% to 20.2%.
Conclusions:
- Pediatric ASM prescribing in France is shifting towards newer, safer agents.
- Generic penetration of ASMs remains limited, despite potential cost savings.
- Targeted substitution strategies could optimize spending for innovative pediatric epilepsy therapies.
Background:
Epilepsy is the commonest chronic neurological disorder of childhood. In France, pregnancy-prevention rules and generic policies aim to improve safety and affordability of anti-seizure medications (ASM), but their paediatric impact is unknown. Tracking these patterns is key to assess policy effectiveness and to ensure safe, equitable, and sustainable access to treatment. We aimed to characterise nationwide temporal trends in paediatric ASM use, costs, generic uptake, and sex differences in France from 2014 to 2023.
Methods:
We conducted a retrospective drug-utilisation study using open-access OpenMedic files from the French National Health Data System. All dispensing of 24 ASMs to individuals <18 years during 2014-23 were retrieved by product code. Annual users, boxes, and costs were summarised; temporal trends used Spearman tests; multivariable logistic regression modelled sex differences; LASSO selected determinants of generic dispensing.
Findings:
Over the decade, 2,015,504 children consumed 15,748,141 ASM boxes, costing €274.4 million. Annual users increased 24% (from 174,889 to 216,607). Third-generation agents rose 70% (from 98,659 users per year to 168,290), whereas first- and second-generation agents fell 48% (from 1579 to 823) and 28% (from 87,929 to 63,038). Valproate use fell 37% overall (from 58,845 to 37,014) and 62% in girls (from 23,480 to 8975); lamotrigine and levetiracetam rose 49% (from 29,404 to 43,847) and 77% (from 37,290 to 65,940), respectively. Generics accounted for 11.2% of dispensing in 2014 (191,551 boxes) vs 20.2% in 2023 (455,934 boxes). Prescriptions by private psychiatrists and use of gabapentin, pregabalin, lamotrigine, and levetiracetam independently predicted generic uptake. ASM with available generic substitution would have cut 2023 spending by 8% (€3.88 million).
Interpretation:
Paediatric ASM practice in France is rapidly aligning with safer, newer ASM and sex-specific risk mitigation, yet generic penetration lacks. Targeted substitution strategies could release funds for innovative therapies without compromising seizure control.
Funding:
None.
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