Anti-seizure medication in Germany over 25 years: trends in prices and prescription patterns from national data from 2000 to 2024.

PURPOSE: To analyse trends in the prices and prescription volumes of anti-seizure medications (ASMs) in Germany from 2000 to 2024.

METHOD: Data on prescription frequencies and costs per defined daily dose (DDD) were derived from annual prescription records (Arzneiverordnungs-Report). Gabapentoids such as gabapentin and pregabalin were excluded to avoid bias related to their common use for non-epilepsy indications. An interrupted time-series analysis (ITSA) using the Prais-Winsten approach was used to identify possible change points and consecutive effects on level and slope of ASM cost development.

RESULTS

Over the 25-year period, levetiracetam rose from 0% to approximately 35% prescription share, becoming the most frequently prescribed ASM in Germany, followed by lamotrigine (∼20%) and valproate (∼16%). Carbamazepine declined from over 45% to below 10%. Newer ASMs including lacosamide, eslicarbazepine, perampanel, brivaracetam, and cenobamate have gained prescription shares since their respective market entries, whilst older enzyme-inducing ASMs have steadily declined. Each new ASM entered the market at high cost per DDD, which decreased substantially following statutory healthcare reforms, reimbursement negotiations or generic availability, which was confirmed by ITSA. Despite continued introduction of newer ASMs, the median cost per DDD has decreased markedly. In 2024, total ASM spending declined to approximately 300 million euros, over 100 million euros less than in 2021.

CONCLUSION

The observed prescription shifts align well with the recommendations of German clinical practice guidelines, which advocate preferential use of lamotrigine and levetiracetam and lacosamide as first-line agents in focal epilepsies, whilst discouraging the use of enzyme-inducing ASMs due to their unfavourable pharmacokinetic interaction profiles and long-term tolerability concerns. The sustained stability of total ASM expenditure indicates that the German pharmaceutical regulatory framework seems to have contributed effectively to contain ASM expenditures whilst maintaining access to therapeutic innovations.