Epilepsy indicator will reduce risk to babies

The NICE QOF review committee has come under criticism for proposing indicators without adequate evidence of their effectiveness (GP, 11 September).

In particular, the proposed indicator for epilepsy has been singled out as lacking a cost-benefit analysis.

If adopted, the indicator would provide an incentive for GPs toensure that women taking anti-epileptic drugs (AEDs) receive vital pre-conception counselling. Epilepsy Action is concerned that such criticism will call the indicator for epilepsy into question and reduce the chance of women receiving this essential pre-conception counselling.

Research shows that children born to women prescribed certain AEDs, such as sodium valproate, have a greater risk of developing neurological and physical disorders including autism and spina bifida.

Pre-conception counselling is designed to reduce the risks tomother and child by allowing women of childbearing age to make informed decisions when planning a family. However, our 2007 survey revealed that only 21 per cent of women with epilepsy received any pre-conception counselling.

NICE acknowledged the difficulty of doing a cost-benefit analysis in its evaluation of this proposed indicator. This is completely understandable given that the ultimate beneficiary of pre-conception counselling is an unborn, often as yet unconceived and even unplanned, child.

The health benefits to the patient should of course be the primary consideration when introducing new health measures. Both mother and baby stand to benefit enormously from this proposed indicator.

However, we firmly believe that the saving to the NHS in avoiding major congenital malformations and neurodevelopmental complications more than justifies any cost.

We sincerely hope that this indicator is adopted to help reduce the risks to both mothers and their children.

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