{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T03:55:25Z","timestamp":1771991725665,"version":"3.50.1"},"reference-count":52,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100020777","name":"Zhejiang Pharmaceutical Association","doi-asserted-by":"publisher","award":["2023ZYJ11"],"award-info":[{"award-number":["2023ZYJ11"]}],"id":[{"id":"10.13039\/501100020777","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020777","name":"Zhejiang Pharmaceutical Association","doi-asserted-by":"publisher","award":["2023ZYJ12"],"award-info":[{"award-number":["2023ZYJ12"]}],"id":[{"id":"10.13039\/501100020777","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020777","name":"Zhejiang Pharmaceutical Association","doi-asserted-by":"publisher","award":["2023ZYY10"],"award-info":[{"award-number":["2023ZYY10"]}],"id":[{"id":"10.13039\/501100020777","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>An increasing number of antiseizure medications (ASMs) are approved for monotherapy for focal epilepsy, but direct comparisons of the lifetime cost\u2010effectiveness of all existing treatment strategies are lacking. This study aims to compare the cost\u2010effectiveness of new ASMs and traditional ASMs as first\u2010line monotherapy for newly diagnosed focal epilepsy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We used a Markov model to evaluate the lifetime cost\u2010effectiveness of 10 ASMs in the treatment of focal epilepsy, with lacosamide (LCM) as a control, from the perspective of society in the United States. Effectiveness, cost data, and health state utilities were obtained from published literature. The cycle of the model is 6\u2009months. Willingness to pay was defined as $150\u2009000 per quality\u2010adjusted life year (QALY). One\u2010way and probabilistic sensitivity analyses were conducted to evaluate parameter uncertainty, and several scenario analyses were also conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The base case analysis showed that carbamazepine (CBZ) was the least costly ASM and more effective than valproic acid (VPA), levetiracetam (LEV), gabapentin (GBP), topiramate (TPM), and lamotrigine (LTG) from an American social perspective. In contrast, oxcarbazepine (OXC), phenytoin (PHT), phenobarbitone (PHB), LCM, and zonisamide (ZNS) were more effective than CBZ, with incremental cost\u2010effectiveness ratios of $334 703.50, $325 610.99, $3 037 148.62, $1 178 954.91, and $108 153 360.85\/QALY, respectively. The traditional ASMs were ranked as CBZ, PHT, VPA, and PHB; the new ASMs were ranked as OXC, LEV, LCM, LTG, TPM, GBP, and ZNS. When generic drugs are used, PHT, OXC, and CBZ remain the three most cost\u2010effective options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>In terms of cost\u2010effectiveness, CBZ monotherapy is the best option for newly diagnosed focal epilepsy, followed by OXC, PHT, VPA, LEV, PHB, LCM, LTG, TPM, GBP, and ZNS. Most traditional ASMs are more cost\u2010effective than new ASMs; OXC is an exception.<\/jats:p><\/jats:sec>","DOI":"10.1111\/epi.18269","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T14:19:18Z","timestamp":1737555558000},"page":"1129-1142","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Which is the most cost\u2010effective antiseizure medication for initial monotherapy for focal epilepsy?"],"prefix":"10.1111","volume":"66","author":[{"given":"Yani","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"},{"name":"School of Pharmaceutical Sciences Wenzhou Medical University  Wenzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fengqian","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"},{"name":"School of Pharmaceutical Sciences Wenzhou Medical University  Wenzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"},{"name":"School of Pharmaceutical Sciences Wenzhou Medical University  Wenzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingyan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5768-2714","authenticated-orcid":false,"given":"Haibin","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Second Affiliated Hospital of Zhejiang University School of Medicine  Hangzhou China"},{"name":"School of Pharmaceutical Sciences Wenzhou Medical University  Wenzhou China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000003509"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1528-1167.2008.01579.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000005755"},{"key":"e_1_2_12_5_1","unstructured":"Excellence NIfHaC.Epilepsies in children young people and adults.2022[cited 2024 7\u201311]. 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