A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial

Marson, Anthony G; Appleton, R; Ga, Baker; Dw, Chadwick; Doughty, Julie; Eaton, Barbara; Gamble, Carrol; Jacoby, Ann; Shackley, Phil; Smith, D W; Tudur-Smith, Catrin; Vanoli, Alessandr a; Williamson, PR

doi:10.3310/hta11370

Cited by 95 publications

(109 citation statements)

References 47 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…This high rate of prescription of carbamazepine might be related to its mood stabilizing properties [3] and the control of the behavioural manifestations of epilepsy [24]. It is likely that most of the patients that present to the psychiatric facility with seizure disorders might be those with predominantly complex partial seizures and behavioural conco- The rate of prescription of sodium valproate observed in this study (8.5%) Open Journal of Psychiatry appears rather low, given that it is also thought to have mood stabilizing effects [27] and is recommended as a drug of choice for primary generalized seizures and in situations in which the seizure type is uncertain [16]. These characteristics make it suitable for use in specialist psychiatric treatment of epilepsy.…”

Section: Seizure Management Strategymentioning

confidence: 82%

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Achor¹,

Nwefoh²,

Ezeala-Adikaibe³

et al. 2017

OJPsych

View full text Add to dashboard Cite

The optimum control of seizures requires adequate dosing of appropriately selected anti-epileptic medications. The availability of AEDs in Nigeria is limited and this constrains the prescription latitude of clinicians. This study was conducted to describe the prescribing pattern of anti-epileptic drugs in the outpatient service of a psychiatric facility in southeast Nigeria. The case records of the epileptic patients attending the outpatient clinic of a psychiatric hospital were retrieved, reviewed and data abstracted with a prepared proforma. The information extracted include age, sex, marital status, residence, type of seizure and anti-seizure medications prescribed, frequency of administration and dosage among other variables. Of the 178 patients whose prescriptions and case records were assessed, males constituted 62.9% and females 37.1%. Most of the patients were single (78.1%) and the group had a mean age of 25.6 ± 10.9 years. Generalized tonic-clonic seizures predominated (61.2%) among the seizure types, whilst complex partial seizure type was identified in 35.4% of the patients. Patient diagnosis relied heavily on the use of clinical description alone. About 92.7% of the patients were treated with monotherapy, whereas 7.3% received two anti-epileptic drug combinations. Carbamazepine was the most frequently prescribed drug, and was utilized in the treatment of 87.9% of patients receiving monotherapy and 92.3% of individuals receiving two drug combinations. Adjunctive medications like benzodiazepines were rarely utilised to improve the effect of the AEDs. The patients that received polytherapy could only be distinguished from those that received 295 Open Journal of Psychiatry monotherapy by higher frequency of epileptic auras and higher mean dose of AEDs per day. The predominant use of monotherapy is in accordance with the treatment recommendations and needs to be encouraged. The greater use of carbamazepine is probably related to its perceived benefits in the control of behavioural symptoms.

show abstract

Section: Seizure Management Strategymentioning

confidence: 82%

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Achor¹,

Nwefoh²,

Ezeala-Adikaibe³

et al. 2017

OJPsych

View full text Add to dashboard Cite

show abstract

“…Healthcare resource use in the SANAD trial was measured by administering a questionnaire to patients at 1 year, which asked about their use of medications, attendance (or admission) to hospital, investigations received and appointments with health care professionals over a 3 month recall period. Resource use was scaled up to a period of 1 year and combined with AED cost, in line with the original trial-based economic analysis [23,24]. This implicitly captured any resources used to manage adverse reactions.…”

Section: Estimating Impact Of Adherence On Health Outcomesmentioning

confidence: 99%

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

Plumpton

Brown

Reuber

et al. 2015

Epilepsy & Behavior

View full text Add to dashboard Cite

Between 35% and 50% of patients with epilepsy are reported not to be fully adherent to their medication schedule. We aimed to conduct an economic evaluation of strategies for improving adherence to antiepileptic drugs. Based on the findings of a systematic review, we identified an implementation-intention intervention (specifying when, where and how to act) which was tested in a trial that closely resembled current clinical management of patients with epilepsy, and which measured adherence with an objective and least biased method. Using patient-level data, trial patients were matched to those recruited to the Standard And New Antiepileptic Drugs trial, according to their clinical characteristics and adherence. Generalised linear models were used to adjust cost and utility in order to estimate the incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the National Health Service in the UK. The mean cost of the intervention group, £1,340 (95% CI £1,132, £1,688) was marginally lower than that of the control group representing standard care £1,352 (95% CI £1,132, £1,727). QALYs in the intervention group were higher than the control, 0.75 (95% CI 0.70, 0.79), compared with 0.74 (95% CI 0.68, 0.79), U"T that the intervention is cost effective at a threshold of £20,000 per QALY is 94%. Our analysis lends support to the cost-effectiveness of a self-directed, implementation-intention intervention for improving adherence to antiepileptic drugs. However, as with any modeling dependent on limited data on efficacy, there is considerable uncertainty surrounding the clinical effectiveness of the intervention which would require a substantive trial for a more definitive conclusion.

show abstract

“…The results were modelled to generate a utility score for every health state defined by 6 dimensions (worry about attacks; depression; memory; concentration; stigma; control). A re-analysis of economic evaluation of an RCT comparing standard versus new antiepileptic drugs [38], revealed a different rank ordering of cost-effectiveness based on the NEWQOL-6D than with the EQ-5D, suggesting that selection of dimensions of health more relevant to epilepsy might affect policy choices. However the increased sensitivity of disease-specific preference-based outcome measures is traded against a loss of comparability of utility across different interventions and a potential insensitivity to side effects and /or comorbidities [39].…”

Section: Choice Of Outcome Measurementioning

confidence: 99%

Conducting Economic Evaluations Alongside Randomised Trials: Current Methodological Issues and Novel Approaches

et al. 2016

View full text Add to dashboard Cite

made substantial contributions to the design and drafting of the work, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dyfrig Hughes will act as the guarantor of the work presented in this paper. 2 Abstract:Trial-based economic evaluations are an important aspect of health technology assessment. The availability of patient-level data coupled with unbiased estimates of clinical outcomes means that randomised controlled trials are effective vehicles for the generation of economic data. However there are methodological challenges to trial-based evaluations, which include the collection of reliable data on resource use and cost, choice of health outcome measure, calculating minimally important differences, dealing with missing data, extrapolating outcomes and costs over time and the analysis of multinational trials. This review focuses on the state of the art of selective elements concerning the design, conduct, analysis and reporting of trial-based economic evaluations. The limitations of existing approaches are detailed and novel methods introduced. The review is internationally relevant but with a focus towards practice in the UK. Key Messages: Trial-based economic evaluations require careful consideration of design, conduct, analysis and reporting.  Areas for improvement include the need for more robust methods to estimate resource utilisation, use of multiple imputation for missing data, and application of appropriate modelling for the assessment of the impact of non-adherence.  This review identifies economic methods that may also enhance clinical trials such as for calculating minimally important differences using discrete choice experiments, and undertaking data extrapolation based on modelling.

show abstract

A randomised controlled trial examining the longer-term outcomes of standard versus new antiepileptic drugs. The SANAD trial

Cited by 95 publications

References 47 publications

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Anti-Epileptic Drug Prescription in a Psychiatric Hospital Outpatient Clinic in Southeast Nigeria

Economic evaluation of a behavior-modifying intervention to enhance antiepileptic drug adherence

Conducting Economic Evaluations Alongside Randomised Trials: Current Methodological Issues and Novel Approaches

Contact Info

Product

Resources

About