An economic evaluation of a multicomponent self‐management intervention for adults with epilepsy (ZMILE study)

Abstract

SUMMARYObjective: The objective of this (trial-based) economic evaluation was, from a societal perspective, to compare the cost-effectiveness of a multicomponent self-management intervention (MCI) with care as usual (CAU) in adult patients with epilepsy over a 12-month period. Methods: In a randomized-controlled trial, participants were randomized into intervention or CAU group. Adherence, self-efficacy (Epilepsy Self-Efficacy Scale [ESES]), quality-adjusted life years (QALYs), healthcare costs, production losses, and patient and family costs were assessed at baseline and during the 12-month study period. Incremental cost-effectiveness ratios (ICERs) (i.e., cost per increased adherence, selfefficacy, or QALY), and cost-effectiveness acceptability curves were calculated. Results: In total, 102 patients were included in the study, of whom 52 were in the intervention group. Adherence rates over 6 months were 63.7% for the CAU group and 75.9% for the intervention group. Adherence, ESES, and quality of life did not differ significantly between groups. An ICER of €54 per point increase in ESES score at 6 months and €1,105 per point increase at 12-month follow-up was found. The intervention resulted in an ICER of €88 per percentage of adherence increase at 6 months. ICERs of €8,272 and €15,144 per QALY gained were found at 6-and 12-month followup, respectively. Significance: Although no statistically significant difference was found after baseline adjustments, cost-effectiveness estimates for MCI appear promising. As rules of inference are arbitrary, it has been argued that decisions should be based only on the net benefits, irrespective of whether differences are statistically significant. Hence, the MCI may be a cost-effective addition to the current standard care for adults with epilepsy.

Effectiveness of a multicomponent self-management intervention for adults with epilepsy (ZMILE study): A randomized controlled trial

“…Instruments used to assess outcome measurements are shown in Table 1. The cost-effectiveness and the process evaluation of the ZMILE-study are reported elsewhere [21,22].…”

ZMILE, a multicomponent self-management intervention for adults with epilepsy: Rationale and description of the intervention

“… 18 Moreover, cost-effectiveness estimates for the ZMILE-intervention appeared to be promising. 19 Therefore, the ZMILE-intervention could prove to be a promising and cost-effective addition to the current standard care for adults with epilepsy.…”

“…In the randomized controlled trial, we compared ZMILE to the standard treatment for the evaluation of its clinical-and cost-effectiveness. 18,19 After completion of the randomized controlled trial, a process evaluation was performed and minor changes were made to the intervention. 20 One of the main changes concerns the use of e-health tools which was an important element of our multicomponent intervention.…”

Self-Management education for adults with poorly controlled epILEpsy [SMILE (UK)]: a randomised controlled trial

“…Few studies have looked at the cost of epilepsy in the UK. We know of a recent Dutch study in which a cost evaluation of a self-management course for epilepsy was undertaken 132 and have collaborated with the trial team in assessing the appropriateness of outcome measures for cost evaluations in epilepsy. 133 Data on health service use and QoL were collected with other secondary outcomes during the trial.…”

“…This is the second economic analysis of a complex intervention for epilepsy, and the first in the UK. 132 10. The economic analysis highlighted the health cost for poorly controlled epilepsy and the capacity burden placed by use of EDs, which is twice as much as for all PWE.…”