OBJECTIVES : Chronic epilepsy is a condition with unpredictable dynamics that significantly reduces life quality in patients. Focal epilepsy is considered the predominant subtype of epilepsy. Despite wide-variety of drug types and therapeutic schemes, epilepsy management lacks gold standard and patients typically put to the test one treatment after another. This review aims to summarize economic evaluation of various anti-epileptic drugs (AEDs) alongside analyzing modelling and methodological approaches implemented.

METHODS : We searched PubMed to identify economic evaluation studies in English for adults with focal epilepsy. Search was restricted to high-income setting particularly countries of the European Union. AEDs therapy schemes including base or adjunctive therapies were considered relevant for this review. Studies evaluating surgical interventions and physiotherapy as well as studies with pediatric population and patients with comorbidities were excluded. Research studies conducted prior 2012 were not included.

RESULTS : Four cost-utility studies for Greece, Finland, Belgium and Sweden reviewed 5 various AEDs prescribed as first-line base or add-on therapy. Each AED was compared to another drug relevant for selected population or absence of treatment. Two different modelling approaches were used: decision-tree and discrete-event simulation employing short-term horizon of 2 to 5 years. Studies generally used similar scope of costs including drug therapy, various types of medical care, costs of adverse events relief, while omitting secondary costs as productivity loss. Overall, reviewed AEDs were found to improve the quality of life of patients at an acceptable threshold, moreover, some AEDs had tendencies of being cost-saving due to the seizure prevention which otherwise requires costly medical help.

CONCLUSIONS : All four studies use resembling modelling and methodological approaches thus allowing for results’ interchangeability. Nevertheless, identified studies poorly justified time horizon or comparator choice. We noted discrepancy along health state definition and ignorance of relevant secondary costs. Further cost inclusion and more explicit design justification will benefit further research.