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NICE guidance under fire for cost ruling on epilepsy drugs

The Government has come under fire over draft guidelines on epilepsy drugs that recommend using older antiepileptics as first line treatment because they are cheap.

Epilepsy experts argued newer antiepilepsy drugs gave patients a better quality of life, had fewer side-effects and should be used despite the extra cost.

The National Institute for Clinical Excellence issued draft guidelines on prescribing drugs for adults and children with epilepsy last week.

The guidelines said newer antiepilepsy drugs, such as lamotrigine, vigabatrin and oxcarbazepine, should only be prescribed to patients who have not benefited from an older drug such as sodium valproate or carbamazepine.

The cost of newer drugs ranges from £40 to £80 a month compared with older drugs, which cost between £2 and £10 per month, according to NICE.

But the guidelines reported 'a high degree of uncertainty around the costs and benefits' of newer antiepilepsy drugs and recommended older treatments be prescribed.

Dr Janet Fitton, a member of the Scottish Intercollegiate Guidelines Network (SIGN) epilepsy guidelines committee, said: 'If you make a decision based on cost of treatment you don't take account of the whole patient experience.'

She argued the new drugs had fewer side-effects so patients were more compliant and enjoyed a better quality of life.

Dr Fitton, a GP in Aberdeenshire, said the SIGN epilepsy guidelines recommended lamotrigine and oxcarbazepine as well as older antiepilepsy drugs as first choice treatments because SIGN was completely evidence based and did not take account of cost.

NICE said the issue of prescribing antiepilepsy drugs to women of childbearing age was a 'major concern' because of the risk of birth defects. These have been found to be two to three times higher in patients on older antiepilepsy drugs.

A lack of trial data prevented recommendations on new antiepileptics but NICE advised sodium valproate should only be used in women of childbearing age with certain types of epilepsy and who have been given informed choice.

Under the quality framework of the new contract, GPs can achieve up to 16 points for setting up an epilepsy register and reviewing treatment and seizure frequency.

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