Position paper of a German interdisciplinary round table on future designs of trials on adjunctive treatment with antiseizure drugs

Antiseizure medication and perceived "fair" cost allocation: a factorial survey among neurologists, persons with epilepsy, their relatives and a control group

OBJECTIVE

As resources are limited in modern healthcare systems, the decision on the allocation of expensive drugs can be supported by a public consent. This study examines how various factors influence subjectively perceived "fair" pricing of antiseizure medication (ASM) among four groups including physicians, persons with epilepsy (PWE), their relatives and a control group.

METHODS

We conducted a factorial survey. Vignettes featured a fictional PWE receiving a fictional ASM. The characteristics of the fictional PWE, ASM and epilepsy varied. Participants were asked to assess the subjectively appropriate annual cost of ASM treatment per year for each scenario.

RESULTS

57 PWE (age 37.7 ± 12.3, 45.6 % females), 44 relatives (age 48.4 ± 15.7, 51.1 % females), 46 neurologists (age 37.1 ± 9.6, 65.2 % females) and 47 persons in the control group (age 31.2 ± 11.2, 68.1 % females) completed the questionnaire. The amount of money that respondents were willing to spend for ASM-treatment was higher than currently needed in Germany and increased with disease severity among all groups. All groups except for PWE accepted higher costs of a drug with better seizure control. Physicians and the control group, but not PWE and their relatives, tended to do so also for minor or no side effects. Physicians reduced the costs for unemployed patients and the control group spent less money for older patients.

SIGNIFICANCE

ASM effectiveness appears to justify higher costs. However, the control group attributed less money to older PWE and physicians allocated fewer drug costs to unemployed PWE.