Article type
Year
Abstract
Background:
Cochrane Reviews typically focus on efficacy and effectiveness and rarely address efficiency which is important for informing resource allocation [1]. Working with the Cochrane Epilepsy Group we aimed to conduct an economic evaluation of evidence sourced from the Cochrane Review of strategies for improving adherence to antiepileptic drugs (AED)[2].
Methods:
The review included five trials that differed appreciably hence we considered it inappropriate to combine data. We focused on the trial most closely resembling current clinical management of patients with epilepsy, which measured adherence with an objective and least biased method and for which we were able to obtain patient-level data to improve the accuracy of the economic evaluation [3]. We calculated an indirect estimate of the impact of the intervention on costs and quality-adjusted life years (QALYs) by matching patients to those recruited to the SANAD trial for which we also had access to patient-level data [4]. Adherence outcomes from the trial were matched to the self-report adherence assessment in SANAD. Generalised linear models adjusted cost and utility for demographics and adherence.
Results:
Fifty-eight (of 69) patients from the adherence trial matched 450 (of 747) patients from SANAD. The mean cost of the intervention group, £740 (95%CI 615-929) is higher than that of the control group £681 (95%CI 515-954). QALYs in the intervention group were significantly higher than the control, 0.82 (95%CI 0.80-0.84), compared with 0.80 (95%CI 0.77-0.83). The incremental cost-effectiveness ratio is £3230/QALY.
Conclusion:
The model indicates that an intervention in which patients note when and where they intend to take their AEDs, and what they would be doing at the moment they will take their medications would be cost-effective in a UK setting, at a threshold of £20,000/QALY. As a source of evidence, Cochrane Reviews proved limited; nevertheless this exercise highlights the importance of identifying economic evidence when conducting a Cochrane Review.
1 Syst Rev 2013, 2:83
2 Cochrane Database Syst Rev 2011, 1
3 Epilepsy Behav 2009, 16:634-9
4 Lancet 2007, 369:1000-15
Cochrane Reviews typically focus on efficacy and effectiveness and rarely address efficiency which is important for informing resource allocation [1]. Working with the Cochrane Epilepsy Group we aimed to conduct an economic evaluation of evidence sourced from the Cochrane Review of strategies for improving adherence to antiepileptic drugs (AED)[2].
Methods:
The review included five trials that differed appreciably hence we considered it inappropriate to combine data. We focused on the trial most closely resembling current clinical management of patients with epilepsy, which measured adherence with an objective and least biased method and for which we were able to obtain patient-level data to improve the accuracy of the economic evaluation [3]. We calculated an indirect estimate of the impact of the intervention on costs and quality-adjusted life years (QALYs) by matching patients to those recruited to the SANAD trial for which we also had access to patient-level data [4]. Adherence outcomes from the trial were matched to the self-report adherence assessment in SANAD. Generalised linear models adjusted cost and utility for demographics and adherence.
Results:
Fifty-eight (of 69) patients from the adherence trial matched 450 (of 747) patients from SANAD. The mean cost of the intervention group, £740 (95%CI 615-929) is higher than that of the control group £681 (95%CI 515-954). QALYs in the intervention group were significantly higher than the control, 0.82 (95%CI 0.80-0.84), compared with 0.80 (95%CI 0.77-0.83). The incremental cost-effectiveness ratio is £3230/QALY.
Conclusion:
The model indicates that an intervention in which patients note when and where they intend to take their AEDs, and what they would be doing at the moment they will take their medications would be cost-effective in a UK setting, at a threshold of £20,000/QALY. As a source of evidence, Cochrane Reviews proved limited; nevertheless this exercise highlights the importance of identifying economic evidence when conducting a Cochrane Review.
1 Syst Rev 2013, 2:83
2 Cochrane Database Syst Rev 2011, 1
3 Epilepsy Behav 2009, 16:634-9
4 Lancet 2007, 369:1000-15