Cost-effectiveness analysis of topiramate versus phenobarbital in the treatment of children with febrile seizure in Shiraz
Iranian Journal of Child Neurology,
Vol. 13 No. 4 (2019),
1 Mehr 2019
,
Page 109-120
https://doi.org/10.22037/ijcn.v13i4.22206
Abstract
Background: Febrile seizure is the most common disorder in childhood, with a prevalence of 2% to 5%. There are many drugs for treatment of this disease; however, the most common prescribed medication in Iran is phenobarbital that is cheap, but it has many side effects. Topiramate is a medication with fewer side effects that is currently prescribed in Iran only for patients with epilepsy; also, it has recently been prescribed and tested for children with febrile seizure. The aim of this study was to compare the cost-effectiveness of topiramate versus phenobarbital in patients with febrile seizure in the south of Iran in 2017.
Methods: This econometric cost-effectiveness and cost-utility study was conducted on 91 patients with febrile seizure to assess two strategies of oral drug therapy including phenobarbital and topiramate in 2016-2017. Of all, 51 patients were treated with phenobarbital and 40 patients received topiramate. In order to collect the required data, we followed up the patients for six months, using a randomized and single-blinded approach. In this study, a decision tree model was used. The outcomes of the model included febrile seizure and utility. The study was conducted from the perspective of the community; therefore, direct and indirect costs were included in the study. Excel and TreeAge software (2011) were used to analyze the results.
Results: The results showed that topiramate was cheaper and more effective than phenobarbital. In patients in the phenobarbital and topiramate groups, the mean costs were $740 and $674 per ppp, utility scores were 0.72 and 0.82, and febrile seizure without side effects were 0.3 and 0.6, respectively. Moreover, one-way sensitivity analysis confirmed the robustness of the results of the study.
Conclusion: According to the results, topiramate in patients with febrile seizure is a fully cost-effective and cost-efficient strategy that can be suggested as a better alternative for children with febrile seizure.
- Febrile seizure
- Topiramate
- Phenobarbital
- Cost-effectiveness
- and cost-utility
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References
References
-American Academy of Pediatrics Steering
Committee on Quality Improvement and
Management, Subcommittee on Febrile
Seizures. Febrile seizures: clinical practice
guideline for the long-term management of the
child with simple febrile seizures. Pediatrics
;121(6):1281-1286.
- Fetveit A. Assessment of febrile seizures in children. EuroJ Pediatr. 2008; 167(1):17-27.
-Baumann RJ. Technical report: treatment of
the child with simple febrile seizure. J Pdiatrcs
, 103(6), 1-57.
- Singh NA, Pappas C, Dahle J, Claes LRF, Pruess TH, Jonghe PD, et al. A Role of SCN9A in Human Epilepsies, As a Cause of Febrile Seizures and As a Potential Modifier of DravetSyndrome.PLoS Genet. 2009.
- Li N, Chen YZ, Zhou KY. Changing trends and clinical characteristics of febrile seizures in children.Zhongguo Dang Dai Er Ke Za Zhi.2015; 17(2):176-9.
-Seinfeld DOS, Pellock JM. Recent Research on Febrile Seizures: A Review. J Neurol Neurophysiol. 2013; 4(165):19519.
-Wirrell E, Turner T. Parental anxiety and family disruption fol¬lowing a first febrile seizure in childhood. Paediatr Child Health. 2001; 6(3):139-43.
- Hirose S, Mohney RP, Okada M, Kaneko S, Mitsudome A. The ge¬netics of febrile seizures and related epilepsy syndromes. Brain Dev. 2003; 25(5):304-12
-Behrman RE, Kliegman RM, Jenson H. Nelson’s text book of pediatrics. 19th ed. Vol III. Philadelphia, USA: Saunders co; 2011; 2457-2458.
- Shinnar S. Febrile seizures. In: Swaiman KF, Ashwal S, Ferriero DM, (eds). Pediatric neurology: principles and practice. 4th ed. Philadelphia: Mosby; 2006.
- Davis, K, Candrilli S. and Edin, H. Prevalence and cost of nonadherence with antiepileptic drugs in an adult managed care population. Epilepsia: 2008; 49: 446–454.
--Arzimanoglon A Consencus development conference on febrile seizures proceedings Epilepsia 1981; 2: 377- 381.
-Privitera MD, Brodie MJ, Mattson RH, Chadwick DW, Neto W, Wang S. Topiramate, carbamazepine and valproate monotherapy: double-blind comparison in newly diagnosed epilepsy. Acta Neurol Scand 2003; 107, 165–175.
- Bazgar M, Shahkhobian B, Alizadeh M. Effect of phenobarbital in the prevention of seizure recurrence in acute phase of febrile illness in children. Medical Journal of Tabriz University of Medical Sciences. 2008; 31(3), 13-17.
- Chung S S. A review of the efficacy and safety of extended-release topiramate in the adjunctive treatment for refractory partial-onset seizures, 2015; 8(3): 131–136.
- Wyllie E, Gupta A, Lachhwani DK. The treatment of epilepsy. Principles and practice. 4th ed. Philadelphia: Lippincott, Williams and Wilkins; 2006.
-Pulman J, Jette N, Dykeman J, Hemming K, Hutton JL, Marson AG. Topiramate add-on for drug-resistant partial epilepsy. Cochrane Database Syst Rev. 2014; (2):1–52.
- Arroyo S, Dodson WE, Privitera MD, et al. Randomized dosecontrolled study of topiramate as first-line therapy in epilepsy. Acta Neurol Scand. 2005; 1(12):214–22.
- Wheless JW, Neto W, Wang S, EPMN-105 Study Group. Topiramate, carbamazepine, and valproate monotherapy: double- blind comparison in children with newly diagnosed epilepsy. J Child Neurol. 2004; 19(2):135–41.
- Guerrini R, Zaccara G, la Marca G, Rosati A. Safety and tolerability of antiepileptic drug treatment in children with epilepsy. Drug Saf. 2012; 35:519–33.
- Arzimanoglon A, Guerrini R, Aicardi J. Aicardi,s Epilepsy in children. 3rd ed, Philadelphia, Lippincutt William and wilkins. 2004; 230-234.
-Wonderling D, Gruen R and Black N. Introduction to health economics. 2007, 271-345.
- Sanches S A, Swildens S A, Busschbach J T V, et al. Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomized controlled trial protocol. BMC Psychiatry 2015; (15), 215-217.
-World Bank . PPP conversion factor, private consumption (LCU per international $) US: The World Bank; Available from: http://www.cbi.ir/ExRates/rates_fa.aspx.
-Chen CY, Chang YJ, Wu HP. New-onset seizures in pediatric emergency. Pediatr Neonatol. 2010 Apr; 51(2): 103-11.
-Selai C E, Smith K, Trimble M. R. Adjunctive therapy in epilepsy: a cost-effectiveness comparison of two AEDs. Seizure, 1999; 8: 8 –13.
-Remak E, Hutton J, Price M, et al. A Markov model of treatment of newly diagnosed epilepsy in the UK: An initial assessment of cost-effectivenessof topiramate. Eur J Health Econom 2003; 4:271–278.
-Verdian L, Yi Y. Cost-utility analysis of rufinamide versus topiramate and lamotrigine for the treatment of children with Lennox–Gastaut Syndrome in the United Kingdom. Seizure2010; 19, 1–11.
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