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

Abstract

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.

A Systematic Review of the Cost-effectiveness of Perampanel in the Treatment of Epilepsy

“…Table 4 shows the results of the incremental cost-effectiveness ratio (ICER) of perampanel in selected studies and sensitivity analysis. In the study of Donger Zhang et al, [14] in China, the ICER of perampanel was much higher than the WTP threshold. However, it was more costeffective than the Lacosamide regime.…”

“…Each study focused on a different population. Donger Zhang et al, studied patients with partial-onset seizures, Gabriel Tremblay et al, investigated primary generalized tonic-clonic seizures (PGTCS), and Saku Väätäinen et al focused on patients with focal onset seizures [12,14,15].…”

“…The studies used other add-on therapeutic regimes to compare with perampanel. For instance, Donger Zhang et al compared perampanel (4mg/day and 8 mg/day) with lacosamide (Lacosamide) (400mg/day and 200 mg/day, respectively) [14]. Meanwhile, Saku Väätäinen et al compared perampanel (4, 6, 8, 10, 12 mg/day) with Brivaracetam (100mg/day).…”

“…They also performed One-way deterministic sensitivity analysis (DSA) and Probabilistic sensitivity analysis (PSA) using Monte Carlo simulation with 10,000 iterations to measure the uncertainty of the result. The threshold used for the willingness-to-pay (WTP) measure was 10,838 -32,515 USD/QALY [14].…”

“…The results of the pooled studies show that the cost of perampanel in the treatment of epilepsy fluctuates. In Donger Zhang et al [14] the author also mentioned that the cost of Perampanel 4 mg/day was 878USD/4 month, and the cost of Perampanel 8 mg/day was 1,754USD/4 month. It was lower than its comparator (i.e.…”