| アブストラクト | BACKGROUND: Some antiepileptic drugs (AEDs) induce expression of hepatic enzymes. This can contribute to comorbidities via interference with metabolic pathways and concomitant drug metabolization, thereby increasing the likelihood of health care interventions. Using medical records, we compared the direct health care cost in patients initiating epilepsy therapy with enzyme-inducing AEDs (EIAEDs) vs non-enzyme-active AEDs (nEAAEDs) over up to 12 years. METHODS: Patients with untreated epilepsy were indexed in the UK Clinical Practice Research Datalink and Hospital Episode Statistics database when prescribed a new EIAED or nEAAED between January 2001 and December 2010. Propensity score matching reduced confounding factors between cohorts. Patients were followed until cohort treatment failure or data cut-off. The primary outcome was the median standardized monthly direct health care cost during follow-up in 2014 poundGBP, calculated using published reference costs and compared using a Mann-Whitney U test. RESULTS: The unmatched EIAED cohort (n = 2752) was older (54 vs 46 years), more likely to be male, had more comorbidities, and higher health care resource use/cost during the 1-year pre-index period (median pound3014 vs pound2516) than the nEAAED cohort (n = 2,137). The most common index EIAED and nEAAED were carbamazepine (63.3%) and lamotrigine (58.0%), respectively. After matching, cohorts had similar features (n = 951 each). Over up to 12 years of follow-up, the median standardized monthly direct health care cost was pound229 for the EIAED and pound188 for the nEAAED cohorts (p = 0.0091). The median cost was higher for the EIAED cohort in every year of follow-up. In the two cohorts, 25.1% and 20.1% of total mean cost during follow-up was epilepsy-related, with approximately 4.6% and 3.0% for AED acquisition, respectively. The median time to cohort treatment failure was shorter in the matched EIAED cohort (468 vs 1194 days). CONCLUSIONS: Patients in the UK who initiated epilepsy therapy with an EIAED appeared to be at higher risk of complications associated with enzyme induction. In long-term matched cohort analyses, the median total direct health care cost associated with EIAED therapy was higher than with nEAAEDs. Changing current treatment practices could potentially improve patient outcomes and reduce costs. |
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| ジャーナル名 | BMC neurology |
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| 投稿日 | 2017/3/25 |
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| 投稿者 | Borghs, Simon; Thieffry, Solene; Noack-Rink, Matthias; Dedeken, Peter; Hong, Lai San; Byram, Laura; Logan, John; Chan, Jane; Kiri, Victor |
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| 組織名 | UCB Pharma, Slough, UK. simon.borghs@ucb.com.;UCB Pharma, Brussels, Belgium.;UCB Pharma, Monheim Am Rhein, Germany.;Redsen Limited, Bournemouth, UK.;UCB Pharma, Slough, UK.;Stats4Pharma, Cork, Ireland.;FV & JK Consulting Ltd., Guildford, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/28335764/ |
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