Objective: Lamotrigine as add-on treatment (500 mg per day) is effective in patients with refractory epilepsy, but its high cost requires
a pharmacoeconomic analysis. We conducted a retrospective lifetime cost–utility study in which clinical data were derived
from a recent placebo-controlled clinical trial, cost-of-illness data were drawn from a previous ad-hoc study, and quality-of-life
values were obtained by prospectively interviewing a separate group of 81 patients referred to our institution with epilepsy.
Results: Our analysis showed that chronic lamotrigine treatment implies an incremental lifetime cost of about $1 600 000 for every
100 patients. Incremental lifetime utility was around 40 quality-adjusted life-years (QALYs) for every 100 patients. On the
basis of these data, adjunctive lamotrigine was estimated to cost approximately $1 600 000 for every
100 patients. Incremental lifetime utility was around 40 quality-adjusted life-years (QALYs) for every 100 patients. On the
basis of these data, adjunctive lamotrigine was estimated to cost approximately 41 000 per QALY gained. Sensitivity testing
suggested a range of $25 000–$25 000–85 000 per QALY gained.
Conclusion: Adjunctive lamotrigine (500 mg per day) in refractory epilepsy seems to have a worse pharmacoeconomic profile than many
pharmacological treatments commonly used in areas other than epilepsy. Further data are needed to determine if lamotrigine
can be equally effective at lower (and less costly) daily doses which could markedly improve its pharmacoeconomic characteristics.
Key words Lamotrigine - Refractory epilepsy
Received: 5 September 1996 / Accepted in revised form: 25 September 1997