Net Gains May Support Cost-effectiveness of Epilepsy Self-management Program, Study Suggests

Net Gains May Support Cost-effectiveness of Epilepsy Self-management Program, Study Suggests

A multicomponent self-management intervention for adults with epilepsy did not significantly improve disease-related quality of life or other disease-related measures compared to usual care in a clinical trial.

Nevertheless, researchers suggest that the intervention might be cost-effective, if net benefits are considered without taking into account whether differences in medication adherence rates and quality of life are statistically significant.

The study, “An economic evaluation of a multicomponent self-management intervention for adults with epilepsy (ZMILE study),” was published in the journal Epilepsia.

As good self-management is known to improve outcomes in patients with epilepsy, many attempts to raise awareness or provide information about self-care have been studied in clinical trials.

Despite this, evidence is lacking about the effectiveness of such programs. Researchers at the CAPHRI School for Public Health and Primary Care of Maastricht University in the Netherlands measured a range of parameters, studied in a clinical trial of one such program.

The clinical trial enrolled 102 patients, randomized to receive either the multicomponent self-management intervention or usual care. Although researchers took measures to compose two similar groups, those in the intervention group were significantly more likely to have a paid job.

They also scored higher on a so-called self-efficacy analysis — defined as the confidence to carry out a behavior necessary to reach a desired goal.

The intervention was composed of group sessions, use of an electronic medication monitoring system, the use of a smartphone application to measure seizures and triggers, and an internet-accessible patient database holding information gathered by the smartphone application.

The group sessions focused on several practical self-management strategies, including the recognition of potential stressors and preliminary coping efforts.

Analyses showed that over six months, patients in the intervention group had a medication adherence rate of 75.9 percent. Those receiving usual care had a somewhat lower treatment adherence — 63.7 percent. This difference was not statistically significant. Quality of life measurements were also similar in the two groups.

The research team then calculated what they called incremental cost-effectiveness ratios (ICERs) — the cost per increased medication adherence, self-efficacy, or quality of life measures.

Although the differences between the groups in terms of these factors had not been significant, cost-effectiveness analyses looked promising, researchers said.

They suggested that despite a lack of significant differences, it might be more accurate to base treatment decisions on net gains. Looking at it in this way, the multicomponent self-management intervention may be a cost-effective intervention for adult epilepsy, they argued.

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