Budget impact of perampanel as adjunctive treatment of uncontrolled partial-onset and primary generalized tonic–clonic seizures in the United States

Tremblay, Gabriel; Barghout, Victoria; Patel, Vardhaman; Tsong, Wan; Wang, Zhixiao

doi:10.1016/j.yebeh.2016.12.029

Cited by 7 publications

(11 citation statements)

References 35 publications

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“…Moreover, the time horizon of our model is the patient's lifetime. Based on the BIA, this study is in agreement with the results of Tremebly et al ( 19 ) for PER; that is, PER as an add-on brings about an increase in BI year by year while also resulting in a medical service cost savings. This result is mainly attributed to the improvement of health state after the use of PER, which in turn reduces the direct medical costs.…”

Section: Discussionsupporting

confidence: 92%

“…In the 2018 guidelines from the American Academy of Neurology and the American Epilepsy Association (AAN/AES), the grades of evidence-based recommendation for PER and LCM are A and B, respectively ( 11 ). Cost-effectiveness (CE) evidence and budget impact analysis (BIA) of PER have been reported in other countries ( 18 , 19 ). Some studies have also explored the CE of LCM as an add-on to conventional AED therapy ( 20 , 21 ).…”

Section: Introductionmentioning

confidence: 99%

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Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis

Zhang

Ding

et al. 2021

Front. Public Health

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Introduction: China has ~6 million patients with active epilepsy every year, around 60% of whom suffer from partial-onset seizures. Perampanel (PER) is a novel anti-epileptic drug for partial-onset seizures. PER has been included in the latest Chinese National Reimbursement Drug List (NRDL) in 2020. However, there is still a lack of evaluation evidence on the value of PER in China.Methods: This study selected a health system perspective. A Markov model was established to simulate the lifelong transition of different response levels and calculate the number of seizures in Chinese patients. Based on the utility value and mortality risk, the life years and quality-adjusted life years (QALYs) of patients using PER vs. lacosamide (LCM) were estimated. Efficacy data were derived from clinical trials and the literature. Cost data (in US dollars) included drug costs and medical service costs. A lifetime horizon was adopted. Health outcomes and costs were discounted at an annual discount rate of 5%. Deterministic sensitivity analysis, probability sensitivity analysis, and scenario analysis were performed. The impact of the inclusion of PER in the NRDL on the medical insurance budget over 3 years (2021–2023) was also estimated.Results: Cost-effectiveness analysis indicates that 8 mg/day of PER increases QALYs by 0.054 and saves costs by $2,390 compared with 400 mg/day of LCM. 4 mg/day of PER increases QALYs by 0.010 and saves costs by $860 compared with 200 mg/day of LCM. Deterministic sensitivity analysis reveals that utility value and the extreme discount rate are the factors with the greatest impact on the incremental cost-effectiveness ratio. Probabilistic sensitivity analysis and scenario analysis show that the results are robust. Budget impact analysis indicates that after inclusion of PER in the NRDL, the incremental budget would be $1.28, $2.83, and $4.56 million from 2021 to 2023, respectively, but covering more eligible epileptic patients in the same time (1,918, 4,287, and 8,983, respectively).Conclusion: PER (8 or 4 mg/day) is of relatively high value as an add-on therapeutic regimen for partial-onset seizures in China because of its dominate advantage of cost-effectiveness over LCM and acceptable budget impact.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis

Zhang

Ding

et al. 2021

Front. Public Health

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“…A Markov model was used to estimate costs due to epilepsy‐related events. Annual epilepsy‐related event frequency and cost was adopted from a past epilepsy pharmacotherapy study that estimated the incidence of various events that incur direct costs (e.g., emergency room visits, inpatient admissions, office visits) based on four absolute seizure frequency groups: Group 1 (>weekly), Group 2 (weekly–monthly), Group 3 (monthly–yearly), and Group 4 (<yearly; Table ) 29 …”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

et al. 2021

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Objective We evaluated the incremental cost‐effectiveness of responsive neurostimulation (RNS) therapy for management of medically refractory focal onset seizures compared to pharmacotherapy alone. Methods We created and analyzed a decision model for treatment with RNS therapy versus pharmacotherapy using a semi‐Markov process. We adopted a public payer perspective and used the maximum duration of 9 years in the RNS long‐term follow‐up study as the time horizon. We used seizure frequency data to model changes in quality of life and estimated the impact of RNS therapy on the annual direct costs of epilepsy care. The model also included expected mortality, adverse events, and costs related to system implantation, programming, and replacement. We interpreted our results against societal willingness‐to‐pay thresholds of $50 000, $100 000, and $200 000 per quality‐adjusted life year (QALY). Results Based on three different calculated utility value estimates, the incremental cost‐effectiveness ratio (ICER) for RNS therapy (with continued pharmacotherapy) compared to pharmacotherapy alone ranged between $28 825 and $46 596. Multiple sensitivity analyses yielded ICERs often below $50 000 per QALY and consistently below $100 000/QALY. Significance Modeling based on 9 years of available data demonstrates that RNS therapy for medically refractory epilepsy very likely falls within the range of cost‐effectiveness, depending on method of utility estimation, variability in model inputs, and willingness‐to‐pay threshold. Several factors favor improved cost‐effectiveness in the future. Given the increasing focus on delivering cost‐effective care, we hope that this analysis will help inform clinical decision‐making for this surgical option for refractory epilepsy.

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“… 52 – 54 According to a study completed using a hypothetical health plan model of 1 million people, the drug has been estimated to have a per person budget impact of $0.0055 after 5 years due to the corresponding decrease in direct and indirect medical costs. 55 The cost to payers is expected to be minimal, while the cost to society is close to neutral.…”

Section: Introductionmentioning

confidence: 99%

Spotlight on perampanel in the management of seizures: design, development and an update on place in therapy

Faulkner¹

2017

DDDT

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PurposePerampanel is a first-in-class antiepileptic medication approved for the treatment of partial (focal) seizures, and as adjunctive treatment for primarily generalized tonic–clonic seizures. The pharmacology, efficacy data, adverse-effect profile, pharmacokinetics and place in therapy are reviewed.SummaryPerampanel is indicated for use in patients with epilepsy who are 12 years of age or older. It is the first medication designed specifically to be a non-competitive antagonist at post-synaptic α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate receptors. Efficacy in refractory seizures has been established, and ongoing efficacy demonstrated by post-marketing data. The drug is completely absorbed, and exhibits a half-life that allows for once-daily administration in doses up to 12 mg/day. Drug interactions are minimal, but increased doses may be necessary when given with strong inducers of cytochrome P450 enzymes, including when perampanel is co-administered with other antiepileptics that exhibit this property. The most common adverse effects noted in both clinical trials and post-marketing are dizziness and somnolence. Psychiatric and behavioral adverse events have been documented in both adult and pediatric patients, including those with no corresponding diagnostic history.ConclusionPerampanel is a novel adjunctive antiepileptic medication that is an effective option for adolescents and adults with partial seizures, and primarily generalized tonic–clonic seizures uncontrolled with other medications.

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Budget impact of perampanel as adjunctive treatment of uncontrolled partial-onset and primary generalized tonic–clonic seizures in the United States

Cited by 7 publications

References 35 publications

Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis

Value of Perampanel as Adjunctive Treatment for Partial-Onset Seizures in Epilepsy: Cost-Effectiveness and Budget Impact Analysis

Cost‐effectiveness analysis of responsive neurostimulation for drug‐resistant focal onset epilepsy

Spotlight on perampanel in the management of seizures: design, development and an update on place in therapy

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