Cost-effectiveness of treatments in neurological diseases
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Researchers have recently published the results of three clinical trials of interventions in epilepsy and sciatica.

The Standard and New Antiepileptic Drugs (SANAD II) trials, compared a range of antiepileptic drugs for how well they control seizures, their general tolerability, and their cost-effectiveness, to assess whether newer drugs should be recommended as first-line treatments. This involved 1,510 participants, who were followed up for up to six years.

The findings, published in the leading medical journal, The Lancet, concluded that valproate is still the best first choice for generalized epilepsy, while lamotrigine remains the best first-line drug for focal epilepsy.

Investigators assessed the cost-effectiveness of each treatment and calculated that for generalized epilepsy, valproate was more effective and less expensive overall compared to levetiracetam. For patients with focal epilepsy, lamotrigine was cost-effective compared with levetiracetam and zonisamide.

the researcher commented: "Our economic assessments support the clinical results in that treatments which were less effective were also not cost-effective. These findings should lead to a change in clinical practice, away from levetiracetam which has been widely used as a treatment of the first choice."

The NERVES clinical trial compared the clinical effectiveness and cost-effectiveness of surgery with a steroid injection—administered into the lower back, between the spine and spinal cord—in patients with sciatica caused by a "slipped disc." 163 patients were recruited. The results indicated that while there were no significant differences in clinical outcomes, surgery was unlikely to be a cost-effective alternative to steroid injection.

The results of the NERVES trial are expected to influence the way in which patients with sciatica are managed in hospital settings. Surgery is not a cost-effective option for patients who are eligible for a steroid spinal injection. These results highlight the importance of considering economic outcomes in supporting decisions on the best use of health care resources.

The Lancet