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Meta-Analysis
. 2021 Feb;62(2):347-357.
doi: 10.1111/epi.16799. Epub 2021 Jan 8.

Cost-effectiveness of adrenocorticotropic hormone versus oral steroids for infantile spasms

Iván Sánchez Fernández  1   2 , Marta Amengual-Gual  1   3 , Marina Gaínza-Lein  1   4   5 , Cristina Barcia Aguilar  1   6 , Ann Marie Bergin  1 , Christopher J Yuskaitis  1 , Chellamani Harini  1
Affiliations
Meta-Analysis

Cost-effectiveness of adrenocorticotropic hormone versus oral steroids for infantile spasms

Iván Sánchez Fernández et al. Epilepsia. 2021 Feb.

Abstract

Objective: To compare the effectiveness and cost-effectiveness of adrenocorticotropic hormone (ACTH) and oral steroids as first-line treatment for infantile spasm resolution, we performed a systematic review, meta-analysis, and cost-effectiveness study.

Methods: A decision analysis model was populated with effectiveness data from a systematic review and meta-analysis of existing literature and cost data from publicly available prices. Effectiveness was defined as the probability of clinical spasm resolution 14 days after treatment initiation.

Results: We included 21 studies with a total of 968 patients. The effectiveness of ACTH was not statistically significantly different from that of oral steroids (.70, 95% confidence interval [CI] = .60-.79 vs. .63, 95% CI = .56-.70; p = .28). Considering only the three available randomized trials with a total of 185 patients, the odds ratio of spasm resolution at 14 days with ACTH compared to high-dose prednisolone (4-8 mg/kg/day) was .92 (95% CI = .34-2.52, p = .87). Adjusting for potential publication bias, estimates became even more favorable to high-dose prednisolone. Using US prices, the more cost-effective treatment was high-dose prednisolone, with an incremental cost-effectiveness ratio (ICER) of $333 per case of spasms resolved, followed by ACTH, with an ICER of $1 432 200 per case of spasms resolved. These results were robust to multiple sensitivity analyses and different assumptions. Prednisolone at 4-8 mg/kg/day was more cost-effective than ACTH under a wide range of assumptions.

Significance: For infantile spasm resolution 2 weeks after treatment initiation, current evidence does not support the preeminence of ACTH in terms of effectiveness and, especially, cost-effectiveness.

Keywords: cost-effectiveness; decision analysis; infantile spasms; meta-analysis; outcome research.

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References

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