Making epilepsy treatment more affordable: Can rationalizing prescriptions reduce cost? (P3.199)

OBJECTIVE:We investigated if a neurologist could reduce cost of treatment prescribed by a primary care physician (PCP) by reviewing the patient and rationalizing treatment in accordance with available evidence. BACKGROUND:In developing countries like India where neurologists are few and mostly urban, rural epilepsy patients are frequently cared for by PCPs. No 9standardized9 prescribing pattern is followed by PCPs; inclusion of CAM and dietary supplements increases cost of treatment. DESIGN/METHODS:This cross-sectional observational study was conducted on the Lifeline Express, a mobile train hospital which provides several free health services including epilepsy clinics and epilepsy education in rural India. Patients presented in this study were seen at Chatrapur, a rural township in the eastern coastal state of Odisha. Cost of patients9 PCP generated prescriptions was first calculated. These patients were then reviewed and if based on the neurologists9s clinical judgment and available evidence, it was decided to change the PCP9s prescription, the cost of the new prescription was once again calculated. Prescription changes included: antiepileptic drug (AED) modifications and also stopping any complementary alternative medicines (CAM) and /or supplements that had been prescribed specifically for epilepsy. RESULTS:Prescriptions of PCP on the whole were found to be significantly more expensive than specialist prescriptions. When the PCP prescription contained AEDs alone, then a specialist review and revised prescription marginally increased the cost. However, a highly significant reduction in cost was brought about by a specialist9s review and revision of prescription when CAM and/or supplements had been prescribed with or without AEDs by the PCP. CONCLUSIONS:Cost of epilepsy treatment can be reduced by limiting prescriptions to include only those medicines for which there is evidence. Dietary supplements and CAM add to cost of epilepsy treatment and should be avoided. Study Supported by:ICMR research grant to Saloni Kapoor. CEO Lifeline Express, Dr Rajnish Gourh is acknowledged. Disclosure: Dr. Singh has nothing to disclose. Dr. Kapoor has nothing to disclose. Dr. Patterson has nothing to disclose. Dr. Prasad has nothing to disclose. Dr. Sreenivas has nothing to disclose.