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Controversies in Neurology
August 1998

Do New Antiepileptic Drugs Justify Their Expense?

Author Affiliations

From the Department of Neurological Science, The Walton Center for Neurology and Neurosurgery, Liverpool University, Liverpool, England.



Arch Neurol. 1998;55(8):1140-1142. doi:10.1001/archneur.55.8.1140

THE FIELD of antiepileptic drug (AED) therapy has been an unusual one, being dominated by old drugs such as phenobarbitone (introduced in 1912) and phenytoin (introduced in 1938). Until recently drugs such as carbamazepine and valproate sodium, introduced into clinical practice in the early 1970s, were regarded as new drugs. However, in the last 7 to 8 years a number of new and potentially exciting AEDs with novel mechanisms of action have become available worldwide. After an initial inevitable burst of enthusiasm for them, we are now reaching a point where a more realistic assessment of their effectiveness can be made. Purchasers of health care, in particular, increasingly demand information to show that new and inevitably more expensive drugs do have benefits to justify the cost. Because epilepsy represents the most common of neurologic disorders, an indiscriminate switching from old to new AEDs would have considerable economic implications. This observation is confirmed in a survey undertaken in the Mersey region of the United Kingdom during 1992, which showed that although the new drugs represented only 7% of prescriptions to people with epilepsy, they represented 39% of the total drug costs that in their turn accounted for one third of direct medical costs.1

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