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December 02, 2022Research Article

Economic Evaluation of the Community Benefit of the Australian Pregnancy Register of Antiseizure Medications

View ORCID ProfileZanfina Ademi, Clara Marquina, View ORCID ProfilePiero Perucca, Alison Hitchcock, Janet Graham, Mervyn J Eadie, Danny Liew, Terence J. O'Brien, View ORCID ProfileFrank J. Vajda
First published December 2, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201655
Zanfina Ademi
1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
3Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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  • ORCID record for Zanfina Ademi
  • For correspondence: zanfina.ademi@monash.edu
Clara Marquina
1Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
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Piero Perucca
3Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
4Epilepsy Research Centre, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
5Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Health, Melbourne, Australia
6Department of Neurology, Alfred Health, Melbourne, Australia
7Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
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  • ORCID record for Piero Perucca
Alison Hitchcock
7Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
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Janet Graham
7Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
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Mervyn J Eadie
8Department of Medicine, The University of Queensland, Brisbane, Australia
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Danny Liew
2School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
9Adelaide Medical School, University of Adelaide, South Australia, Australia
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Terence J. O'Brien
3Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
6Department of Neurology, Alfred Health, Melbourne, Australia
7Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
10Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia.
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Frank J. Vajda
7Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
10Department of Medicine (The Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia.
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  • ORCID record for Frank J. Vajda
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Citation
Economic Evaluation of the Community Benefit of the Australian Pregnancy Register of Antiseizure Medications
Zanfina Ademi, Clara Marquina, Piero Perucca, Alison Hitchcock, Janet Graham, Mervyn J Eadie, Danny Liew, Terence J. O'Brien, Frank J. Vajda
Neurology Dec 2022, 10.1212/WNL.0000000000201655; DOI: 10.1212/WNL.0000000000201655

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Abstract

Background and Objective: The Raoul Wallenberg Australian Pregnancy Register (APR) was established to collect, analyse and publish data on the risks to babies exposed to anti-seizure medications (ASMs), and to facilitate quality improvements in management care over time. It is one of several prospective observational pregnancy registers of ASMs that has been established around the world. While the APR and other registries have contributed to knowledge gain that has been applied to decrease adverse pregnancy outcomes, their cost-effectiveness remains unknown. Here we aimed to evaluate the economic impacts of the APR from both societal and healthcare system perspectives.

Methods: Using decision-analytic modelling, we estimated the effectiveness (prevention of adverse pregnancy outcomes) and costs (costs of adverse pregnancy outcomes and the register itself) of the APR over a 20-year time horizon (2000-2019). The comparator was set as the adverse pregnancy outcomes collected by the APR between 1998 and 2002 (i.e., no APR derived improvements in care). In the scenario analysis we conservatively assumed a 2.5% and 5% contribution of the APR to the savings in healthcare and societal costs. Adverse pregnancy outcomes included stillbirth, birth defects and induced abortion. All cost data were derived from published sources. Health and economic outcomes were extrapolated to the total target Australian epilepsy population. The primary outcomes of interest were the return of investment (ROI) for the APR and incremental cost-effectiveness ratio (ICER) in terms of cost per adverse outcome avoided.

Results: Over the 20-year time horizon, the ROI from the APR from a societal perspective was AUD 2,250 (i.e. every dollar spent on the program resulted in a return of AUD2,250). Over this time, it was estimated that 9,609 adverse pregnancy outcomes were avoided, and healthcare and societal costs were reduced by AUD 191 million and AUD 9.0 billion, respectively. Hence from a health economic point of view, the APR was dominant, providing cost-saving ICERs from both perspectives.

Conclusion: Following its inception 20+ years ago, the APR has represented excellent value for investment for Australia, being also health-saving and cost-saving from a societal and a healthcare perspective. With the growing number of marketed ASMs, the APR is expected to continue to have a major impact in the foreseeable future.

  • Received June 3, 2022.
  • Accepted in final form October 19, 2022.
  • © 2022 American Academy of Neurology

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