Evidence map›Paper›PMID 36460471›Full record

Observational studyNeurology2023

Economic Evaluation of the Community Benefit of the Australian Pregnancy Register of Antiseizure Medications.

Zanfina Ademi, Clara Marquina, Piero Perucca, Alison Hitchcock, Janet Graham, Mervyn J Eadie, Danny Liew, Terence J O'Brien, Frank J Vajda

Open access · greenAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
0.4field-weighted citation impact, top 34% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed, 1 citations in OpenAlex.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Zanfina AdemiFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia. zanfina.ademi@monash.edu.ORCID 0000-0002-0625-3522
Clara MarquinaFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Piero PeruccaFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Alison HitchcockFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Janet GrahamFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Mervyn J EadieFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Danny LiewFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Terence J O'BrienFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.
Frank J VajdaFrom the Centre for Medicine Use and Safety (Z.A., C.M.), Faculty of Pharmacy and Pharmaceutical Sciences, School of Public Health and Preventive Medicine (Z.A., D.L.), Department of Neuroscience (Z.A., P.P., T.J.O.B.), Central Clinical School, Monash University, Melbourne; Epilepsy Research Centre (P.P.), Department of Medicine (Austin Health), The University of Melbourne; Bladin-Berkovic Comprehensive Epilepsy Program (P.P.), Department of Neurology, Austin Health, Melbourne; Department of Neurology (P.P., T.J.O.B.), Alfred Health, Melbourne; Department of Neurology (P.P., A.H., J.G., T.J.O.B., F.J.V.), The Royal Melbourne Hospital; Department of Medicine (M.J.E.), The University of Queensland, Brisbane; Adelaide Medical School (D.L.), University of Adelaide, South Australia; and Department of Medicine (The Royal Melbourne Hospital) (T.J.O.B., F.J.V.), The University of Melbourne, Australia.ORCID 0000-0001-5570-7538
Monash University · AUThe Royal Melbourne Hospital · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveThe Raoul Wallenberg Australian Pregnancy Register (APR) was established to collect, analyze, and publish data on the risks to babies exposed to antiseizure medications (ASMs) and to facilitate quality improvements in management care over time. It is one of the seveal prospective observational pregnancy registers of ASMs that has been established around the world. Although the APR and other registries have contributed to knowledge gain that has been applied to decrease adverse pregnancy outcomes, their cost-effectiveness remains unknown. Here, we aimed to evaluate the economic impacts of the APR from both societal and health care system perspectives.

methodsUsing decision analytic modeling, we estimated the effectiveness (prevention of adverse pregnancy outcomes) and costs (costs of adverse pregnancy outcomes and the register itself) of the APR over a 20-year time horizon (2000-2019). The comparator was set as the adverse pregnancy outcomes collected by the APR between 1998 and 2002 (i.e., no APR derived improvements in care). In the scenario analysis, we conservatively assumed a 2.5% and 5% contribution of the APR to the savings in health care and societal costs. Adverse pregnancy outcomes included stillbirth, birth defects, and induced abortion. All cost data were derived from published sources. Health and economic outcomes were extrapolated to the total target Australian epilepsy population. The primary outcomes of interest were the return of investment (ROI) for the APR and incremental cost-effectiveness ratio (ICER) for cost per adverse outcome avoided.

resultsOver the 20-year time horizon, the ROI from the APR from a societal perspective was Australian dollars (AUD) 2,250 (i.e., every dollar spent on the program resulted in a return of AUD2,250). Over this time, it was estimated that 9,609 adverse pregnancy outcomes were avoided, and health care and societal costs were reduced by AUD 191 million and AUD 9.0 billion, respectively. Hence, from a health economic point of view, the APR was dominant, providing cost saving ICERs from both perspectives. DISCUSSION: Following its inception 20+ years ago, the APR has represented excellent value for investment for Australia, being also health-saving and cost saving from a societal and a health care perspective. With the growing number of marketed ASMs, the APR is expected to continue to have a major impact in the foreseeable future.

Indexed as

Cost-Benefit AnalysisAustraliaFemaleHumansPregnancyRegistries

Identifiers

PMID36460471
PMCPMC9990855
OpenAlexW4310643643

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.