Budget impact analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands
- PMID: 39686574
- DOI: 10.1080/13696998.2024.2443338
Budget impact analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands
Abstract
Objective: The objective of this study was to explore the financial consequences of adopting cenobamate as a treatment alternative in epilepsy patients with drug-resistant focal onset seizures (FOS) from a societal perspective in the Netherlands.
Methods: A previous budget impact model with a 5-year time horizon was adapted to the Dutch setting accounting for the eligible population, real-world market shares, treatment effectiveness and resource use in two scenarios: cenobamate with constant market share versus cenobamate with linearly increased market share up to 20%. Clinical inputs included treatment response, seizure reduction and adverse events. Costs consisted of drugs, medical and non-medical costs. One-way sensitivity analysis and scenario analysis were conducted to test the robustness of our results.
Results: 14,723 patients were eligible for cenobamate in 2022. Although cenobamate adds a gross budget impact of €12,686,30, the displacement of other drugs yields a total impact on the drug budget of €3,722,596 over 5 years. Adopting cenobamate resulted in a medical cost savings of €13,499,498 due to less resource use, and non-medical cost savings of €22,144,054 due to reduced productivity losses. Overall, savings generated at medical and non-medical cost level offset the gross drug budget impact of cenobamate, resulting in a saving of €31,920,955 over 5 years. Results were robust in the sensitivity/scenario analyses.
Conclusion: Treatment with cenobamate is associated with both medical and non-medical cost savings, which offset the increase in drug budget and result in a significant potential budget saving. The higher the market share of cenobamate, the larger the budget savings. We acknowledge several limitations; Complex scenarios such as drug interactions, stopping/switching drugs, and multiple drug use were not taken into account. The long-term efficacy and safety of cenobamate and its comparators remains uncertain. Future real-world data are needed to confirm our findings.
Keywords: Budget impact analysis; E52; I18; anti-seizure medication; cenobamate; focal onset seizures; refractory epilepsy.
Plain language summary
This study examined the financial impact of introducing cenobamate as a treatment option for people with drug-resistant focal onset seizures in the Netherlands. The analysis looked at two scenarios: one where market share of cenobamate remained constant and another where it gradually increased to 20% over five years. The researchers found that despite introducing cenobamate added approximately €12.7 million in drug costs over five years, the displacement of other drugs resulted in a total impact on the drug budget of €3.7 million. More importantly, given the higher treatment response and seizure reduction, the adoption of cenobamate was associated with significant medical cost savings of €13.5 million due to less healthcare resource utilization, and non-medical savings of €22.1 million due to reduced productivity losses. Overall, the combined savings in medical and non-medical costs far outweighed the impact of cenobamate on the drug budget, resulting in a net saving of €31.9 million over five years. This analysis suggests that adopting cenobamate could lead to both health and economic benefits for society.
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