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Cost-effectiveness of cenobamate for focal seizures in people with drug-resistant epilepsy.
Laskier, Vicki; Agyei-Kyeremateng, Kenneth K; Eddy, Alex E; Patel, Dilip; Mulheron, Stuart; James, Samuel; Thomas, Rhys H; Sander, Josemir W.
Afiliação
  • Laskier V; FIECON, Hodgkin Huxley House, London, UK.
  • Agyei-Kyeremateng KK; FIECON, Hodgkin Huxley House, London, UK.
  • Eddy AE; FIECON, Hodgkin Huxley House, London, UK.
  • Patel D; Angelini Pharma UK-I, London, UK.
  • Mulheron S; Angelini Pharma UK-I, London, UK.
  • James S; Angelini Pharma UK-I, London, UK.
  • Thomas RH; Department of Neurology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
  • Sander JW; Translational and Clinical Research Institute, Newcastle, UK.
Epilepsia ; 64(4): 843-856, 2023 04.
Article em En | MEDLINE | ID: mdl-36625423
OBJECTIVE: This study was undertaken to estimate the cost-effectiveness of add-on cenobamate in the UK when used to treat drug-resistant focal seizures in adults who are not adequately controlled with at least two prior antiseizure medications, including at least one used adjunctively. METHODS: We estimated the cost per quality-adjusted life-year (QALY) for cenobamate compared to brivaracetam, eslicarbazepine, lacosamide, and perampanel in the UK National Health Service over a lifetime time horizon. We used a Markov cohort structure to determine response to treatment, using pooled data from three long-term studies of cenobamate. A network meta-analysis informed the likelihood of response to therapy with brivaracetam, eslicarbazepine, lacosamide, and perampanel relative to cenobamate. Once individuals discontinued treatment, they transitioned to subsequent treatment health states, including other antiseizure medicines, surgery, and vagus nerve stimulation. Costs included treatment, administration, routine monitoring, event management, and adverse events. Published evidence and expert opinion informed the likelihood of response to subsequent treatments, associated adverse events, and costs. Utility data were based on Short-Form six-dimension form utility. Discounting was applied at 3.5% per annum as per National Institute for Health and Care Excellence guidance. Uncertainty was explored through deterministic and probabilistic sensitivity analyses. RESULTS: In the base case, cenobamate led to cost savings of £51 967 (compared to brivaracetam), £21 080 (compared to eslicarbazepine), £33 619 (compared to lacosamide), and £28 296 (compared to perampanel) and increased QALYs of 1.047 (compared to brivaracetam), 0.598 (compared to eslicarbazepine), 0.776 (compared to lacosamide), and 0.703 (compared to perampanel) per individual over a lifetime time horizon. Cenobamate also dominated the four drugs across most sensitivity analyses. Differences were due to reduced seizure frequency with cenobamate relative to comparators. SIGNIFICANCE: Cenobamate improved QALYs and was less costly than brivaracetam, eslicarbazepine, lacosamide, and perampanel. Therefore, cenobamate may be considered as a cost-effective adjunctive antiseizure medication for people with drug-resistant focal seizures.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicina Estatal / Epilepsia Resistente a Medicamentos Tipo de estudo: Guideline / Health_economic_evaluation / Systematic_reviews Limite: Adult / Humans Idioma: En Revista: Epilepsia Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Medicina Estatal / Epilepsia Resistente a Medicamentos Tipo de estudo: Guideline / Health_economic_evaluation / Systematic_reviews Limite: Adult / Humans Idioma: En Revista: Epilepsia Ano de publicação: 2023 Tipo de documento: Article