Determination of the economically justifiable price of cenobamate in the treatment of focal-onset seizures in adult patients with drug-resistant epilepsy in Spain.

Fecha de publicación: 03/08/2022 Fecha Ahead of Print: 01/08/2022

Autores de IIS La Fe

• Vicente Enrique Villanueva Haba

  Autor

Participantes ajenos a IIS La Fe

• Angel Calleja, Miguel
• Navarro, Andres
• Serratosa, Jose Maria
• Toledo, Manuel
• Subias Labazuy, Silvia
• Gil, Alicia

Abstract

Objective To determine the economically justifiable price (EJP) of cenobamate to become a cost-effective alternative compared with third-generation anti-seizure medications in the treatment of focal-onset seizures (FOS) in adult patients with drug-resistant epilepsy (DRE) in Spain. Methods Cost-effectiveness analysis compared cenobamate with brivaracetam, perampanel, eslicarbazepine acetate, and lacosamide. Markov model simulation of treatment pathway over a 60-year time horizon is presented. We determined the effectiveness and quality-adjusted life-years (QALYs) of health status and disutilities associated with treatment-related adverse events. Acquisition costs and use of medical resources were obtained from published literature and expert opinion. Base-case of cenobamate's EJP calculated applying a willingness-to-pay (WTP) threshold of euro21,000/QALY. Analyses were performed at different thresholds, including dominant price scenario. Result robustness was assessed through sensitivity analyses. Results Base-case shows that cenobamate's daily EJP of euro7.30 is cost-effective for a threshold of euro21,000/QALY. At a daily price of euro5.45, cenobamate becomes dominant over all treatment alternatives producing cost-savings for the national health system (NHS). Sensitivity analyses supported the robustness of base-case findings. Conclusions Treatment with cenobamate produces incremental clinical benefit over third-generation ASMs, and at the base-case, EJP could represent a cost-effective option for the adjunctive treatment of FOS in adult patients with DRE in Spain.

Keywords

• Anti-seizure medications; cenobamate; cost-effectiveness; drug-resistant epilepsy; economically justifiable price; Spain