Beyond consensus: expert assessment of epilepsy pharmacotherapy through the lens of multi-level verification

Background. Epilepsy remission rates in Russia lag behind global figures, which is partly attributable to the fragmentation of approaches to evaluating antiseizure medications (ASMs): the subjectivity of expert opinions, the limited scope of consumption data, and the failure of clinical guidelines to account for regional specificities.

Objective: To develop and test a methodology for comprehensive evaluation of ASMs based on matrix expertise with multilevel verification across four independent data sources to optimize drug provision for epilepsy patients at the regional level.

Material and methods. A structured survey of 32 expert epileptologists from 7 Russian regions was conducted to assess21 ASMs using a 10-point scale (therapeutic line and risk). Verification involved comparison with clinical guidelines, practice data, consumption metrics, and a pharmacokinetic safety rating. Concordance was assessed using Kendall's coefficient of concordance (W).

Results. The developed methodology enabled, for the first time, a multi-level verification of expert preferences and the identification of systemic discrepancies in approaches to epilepsy therapy. A divergence was found between expert opinions and clinical guidelines in the treatment of generalized epilepsy, attributable to the challenges of implementing new classification criteria and the evolving nature of therapeutic approaches. The identified mismatch between the proven safety of modern ASMs and their actual positioning in treatment algorithms reflects the influence of economic and organizational barriers.

Conclusion. The proposed methodology serves as an analytical tool for auditing the pharmaceutical supply system, enabling the formation of rational ASM formularies, the substantiation of “negative lists”, and the identification of targeted administrative and educational measures.

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