Qualitative and quantitative improvements of pharmaco-economic evaluation of antiepileptic drugs have been realized during the last decade. Assessment of medical treatments is mainly performed through cost-minimization studies, owing to similar effectiveness of AED. Studies recently published generally consider hypothetical cohorts of patients and assess resource utilization and medical effects on the basis of clinical trials and expert panels, limiting evaluation to direct costs. But they differ in numerous ways due to: the type of patients and treatment considered, the time span of evaluation, and cost measurement. Comparison between studies is therefore tricky but it seems that, when considering monotherapy treatments, carbamazepine and phenytoin are somewhat cheaper than valproate while lamotrigine is much more expensive but no more effective. However, these and other antiepileptic agents appear as close substitutes when prescribed as adjunctive treatments. Refined tools have been developed to take into account slight differences exhibited on certain outcomes. One direction currently under evaluation relates to quality of life, and this will probably leads to an increasing number of cost-utility studies. Some advances, regarding information on medical resources consumed and outcomes associated with alternative drugs, as well as methodological options, are still needed to fully develop pharmacoeconomic evaluation of antiepileptic treatments.