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Impact of reimbursement restrictions on the choice of antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET)

Paul Boon UGent, Peter Dejonghe, Benjamin Legros, Bernad Sadzot, Kenou van Rijckevorsel and Eric Schmedding (2008) SEIZURE-EUROPEAN JOURNAL OF EPILEPSY. 17(4). p.350-357
abstract
Background: In Belgium, new and costly antiepileptic drugs (AEDs) are only reimbursed as second-tine treatment, after documented treatment with conventional and cheaper AEDs has failed. The objective of this study was to describe the treatment of epilepsy in Belgium and to analyze the impact of the reimbursement restrictions on the choice of AEDs. Methods: Between May and June 2003, a sample of 100 neurologists, representative of the entire neurological community in teaching, academic, and regional hospitals in Belgium, were personally interviewed on the basis of a structured questionnaire (modified Rand method). The questionnaire contained questions on treatment choices and strategies in adult epilepsy. Results: Unanimously, initial monotherapy was the preferred treatment strategy in all types of epilepsy. In the opinion of most neurologists, valproate was the first choice for idiopathic generalized and focal epilepsy with/without secondary generalization. Carbamazepine as their first choice for the treatment of focal epilepsy. New AEDs were most often prescribed as second-line therapy. Lamotrigine was the most frequently prescribed new AED and used for both generalized and focal epilepsy. It was followed by levetiracetam, topiramate and oxcarbazepine for focal epilepsy. In the absence of reimbursement restrictions, two new AEDs would be significantly more often prescribed as a first-tine therapy: lamotrigine for idiopathic generalized epilepsy and oxcarbazepine for focal epilepsy. Conclusions: The neurologists reached a high level of consensus on many of the key treatment questions. Monotherapy with valproate and carbamazepine was the standard treatment strategy in Belgium. Lamotrigine and less so levetiracetam, topiramate and oxcarbazepine were commonly prescribed as second-line AEDs. In the absence of reimbursement restrictions, lamotrigine and oxcarbazepine would be more frequently prescribed. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (proceedingsPaper)
publication status
published
subject
keyword
survey, consensus, epilepsy, antiepileptic drugs, reimbursement
journal title
SEIZURE-EUROPEAN JOURNAL OF EPILEPSY
Seizure
volume
17
issue
4
pages
350 - 357
publisher
W B SAUNDERS CO LTD
place of publication
London UK
conference name
European Epilepsy Congress
conference location
Vienna, Austria
Web of Science type
Proceedings Paper
Web of Science id
000256227800009
JCR category
CLINICAL NEUROLOGY
JCR impact factor
2.179 (2008)
JCR rank
77/156 (2008)
JCR quartile
2 (2008)
ISSN
1059-1311
DOI
10.1016/j.seizure.2007.11.005
language
English
UGent publication?
yes
classification
A1
id
603102
handle
http://hdl.handle.net/1854/LU-603102
date created
2009-04-28 16:33:20
date last changed
2009-05-04 14:02:40
@article{603102,
  abstract     = {Background: In Belgium, new and costly antiepileptic drugs (AEDs) are only reimbursed as second-tine treatment, after documented treatment with conventional and cheaper AEDs has failed. The objective of this study was to describe the treatment of epilepsy in Belgium and to analyze the impact of the reimbursement restrictions on the choice of AEDs.
Methods: Between May and June 2003, a sample of 100 neurologists, representative of the entire neurological community in teaching, academic, and regional hospitals in Belgium, were personally interviewed on the basis of a structured questionnaire (modified Rand method). The questionnaire contained questions on treatment choices and strategies in adult epilepsy.

Results: Unanimously, initial monotherapy was the preferred treatment strategy in all types of epilepsy. In the opinion of most neurologists, valproate was the first choice for idiopathic generalized and focal epilepsy with/without secondary generalization. Carbamazepine as their first choice for the treatment of focal epilepsy. New AEDs were most often prescribed as second-line therapy. Lamotrigine was the most frequently prescribed new AED and used for both generalized and focal epilepsy. It was followed by levetiracetam, topiramate and oxcarbazepine for focal epilepsy. In the absence of reimbursement restrictions, two new AEDs would be significantly more often prescribed as a first-tine therapy: lamotrigine for idiopathic generalized epilepsy and oxcarbazepine for focal epilepsy.

Conclusions: The neurologists reached a high level of consensus on many of the key treatment questions. Monotherapy with valproate and carbamazepine was the standard treatment strategy in Belgium. Lamotrigine and less so levetiracetam, topiramate and oxcarbazepine were commonly prescribed as second-line AEDs. In the absence of reimbursement restrictions, lamotrigine and oxcarbazepine would be more frequently prescribed. (c) 2007 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.},
  author       = {Boon, Paul and Dejonghe, Peter and Legros, Benjamin and Sadzot, Bernad and van Rijckevorsel, Kenou and Schmedding, Eric},
  issn         = {1059-1311},
  journal      = {SEIZURE-EUROPEAN JOURNAL OF EPILEPSY},
  keyword      = {survey,consensus,epilepsy,antiepileptic drugs,reimbursement},
  language     = {eng},
  location     = {Vienna, Austria},
  number       = {4},
  pages        = {350--357},
  publisher    = {W B SAUNDERS CO LTD},
  title        = {Impact of reimbursement restrictions on the choice of antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET)},
  url          = {http://dx.doi.org/10.1016/j.seizure.2007.11.005},
  volume       = {17},
  year         = {2008},
}

Chicago
Boon, Paul, Peter Dejonghe, Benjamin Legros, Bernad Sadzot, Kenou van Rijckevorsel, and Eric Schmedding. 2008. “Impact of Reimbursement Restrictions on the Choice of Antiepileptic Drugs: Belgian Study on Epilepsy Treatment (BESET).” Seizure-european Journal of Epilepsy 17 (4): 350–357.
APA
Boon, P., Dejonghe, P., Legros, B., Sadzot, B., van Rijckevorsel, K., & Schmedding, E. (2008). Impact of reimbursement restrictions on the choice of antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET). SEIZURE-EUROPEAN JOURNAL OF EPILEPSY, 17(4), 350–357. Presented at the European Epilepsy Congress.
Vancouver
1.
Boon P, Dejonghe P, Legros B, Sadzot B, van Rijckevorsel K, Schmedding E. Impact of reimbursement restrictions on the choice of antiepileptic drugs: Belgian Study on Epilepsy Treatment (BESET). SEIZURE-EUROPEAN JOURNAL OF EPILEPSY. London UK: W B SAUNDERS CO LTD; 2008;17(4):350–7.
MLA
Boon, Paul, Peter Dejonghe, Benjamin Legros, et al. “Impact of Reimbursement Restrictions on the Choice of Antiepileptic Drugs: Belgian Study on Epilepsy Treatment (BESET).” SEIZURE-EUROPEAN JOURNAL OF EPILEPSY 17.4 (2008): 350–357. Print.