Cost-effectiveness of first-line antiepileptic drug treatments in the developing world: A population-level analysis
Cost-effectiveness of first-line antiepileptic drug treatments in the developing world: A population-level analysis
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DOI：
10.1111/j.1528-1167.2005.52704.x
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发表时间：
2005-05-01
期刊：
影响因子：
5.6
通讯作者：
Chisholm, D
中科院分区：
文献类型：
--
作者：
Chisholm, D
目的：建立一线抗癫痫药物（AED）治疗的人口水平成本和成本效益，以减少发展中国家的治疗差距。方法：将人口模型应用于9个世界卫生组织（WHO）发展中次区域，以估计4种一线AED在初级保健管理中的影响。（ICD-10定义）特发性癫痫和癫痫综合征：苯巴比妥（PB）、苯妥英（PHT）、卡马西平（CBZ）和丙戊酸（VPA）。治疗的有效性是根据残疾和恢复的改善来衡量的，随后根据治疗范围、反应和依从性进行调整。总体人群水平治疗效应（以残疾调整生命年或避免的残疾数衡量）和治疗费用（以国际元计算; I$）合并形成成本效益比率。在世卫组织的九个发展中分区域，将AED治疗的覆盖率扩大到50%的原发性癫痫病例将使每百万人口减少150至650个DADs（相当于目前负担的13-40%），每年人均费用为0.20-1.33伊元。老年人的一线抗癫痫药物（PB，PHT）是最具成本效益的帐户，其类似的疗效，但较低的收购成本（I $800 - 2000为每个DALY避免）。结论：一个显着的比例，目前的负担在发展中国家的癫痫是可避免的按比例增加常规提供低成本的抗癫痫药物。除了重新提供政治支持和投资外，成功地扩大服务提供水平的关键因素还涉及适当的培训和药物供应的连续性。
Purpose: To establish the population-level costs and cost-effectiveness of first-line antiepileptic drug (AED) treatments for reducing the treatment gap in developing countries.Methods: A population model was applied to nine World Health Organization (WHO) developing subregions to estimate the impact of four first-line AEDs in the primary care management of (ICD-10 defined) idiopathic epilepsy and epileptic syndromes: phenobarbitone (PB), phenytoin (PHT), carbamazepine (CBZ), and valproic acid (VPA). The efficacy of treatment was gauged in terms of improvements to both disability and recovery, subsequently adjusted for treatment coverage, response, and adherence. Total population-level treatment effects (measured in disability-adjusted life years or DALYs averted) and treatment costs (measured in international dollars; I$) were combined to form ratios of cost-effectiveness.Results: Across nine developing WHO subregions, extending AED treatment coverage to 50% of primary epilepsy cases would avert between 150 and 650 DALYs per one million population (equivalent to 13-40% of the current burden), at an annual cost per capita of I$ 0.20-1.33. Older first-line AEDs (PB, PHT) were most cost-effective on account of their similar efficacy but lower acquisition cost (I$ 800-2,000 for each DALY averted).Conclusions: A significant proportion of the current burden of epilepsy in developing countries is avertable by scaling-up the routine availability of low-cost AEDs. Critical factors in the successful implementation of such a scaled-up level of service delivery, apart from renewed political support and investment, relate to appropriate training and continuity of drug supply.