Eslicarbazepine acetate adjunctive therapy reduces charges related to focal seizures

Patients with focal seizures who initiated first adjunctive therapy with eslicarbazepine acetate vs. brivaracetam had significantly larger reductions in medical charges, as well as in prescription charges unrelated to anti-seizure drugs.

Researchers published the findings in Journal of Medical Economics.

“Pivotal clinical trials have demonstrated the safety and efficacy of [eslicarbazepine acetate] and [brivaracetam] in patients with refractory epilepsy,” Darshan Mehta, PhD, associate director of health economics and outcomes research at Sunovion Pharmaceuticals, and colleagues wrote. “However, [eslicarbazepine acetate] is one of the few third-generation [anti-seizure drugs] for which safety and efficacy have been investigated in a real-world clinical setting, early in the treatment cycle, in a [phase 4] study in adults with [focal seizures]. Although the sample size was small and the study was not powered to detect differences between patients receiving [eslicarbazepine acetate] as first adjunctive therapy to [levetiracetam] or [lamotrigine], and patients with treatment-resistant epilepsy receiving [eslicarbazepine acetate] as later adjunctive therapy, findings showed that [eslicarbazepine acetate] was effective and well-tolerated both as the first adjunctive therapy to [levetiracetam] or [lamotrigine] monotherapy (n = 44) and as later adjunctive therapy in treatment-resistant patients (n = 58).”

According to the researchers, evidence has accumulated regarding the health care resource utilization and cost outcomes for eslicarbazepine acetate in the first line and adjunctive settings. However, comparable data have yet to be accumulated for brivaracetam, given a lack of studies that directly compared resource use for eslicarbazepine acetate with brivaracetam as a first adjunctive therapy. The researchers noted the potential for supporting decision-making among payers, providers and patients, as well as reducing the economic burden linked to focal seizures, by shedding light on differences in health care resource utilization between these drugs.

In the current study, Mehta and colleagues sought to evaluate the relationship between first adjunctive therapy initiation with eslicarbazepine acetate compared with brivaracetam on health care resource utilization and charges among patients with treated focal seizures. They analyzed claims data from a single database between April 1, 2015, and June 30, 2018, to identify two cohorts as first adjunctive therapy with eslicarbazepine acetate (n = 208; 51.9% women; mean age, 43.7 years) or brivaracetam (n = 137; 51.8% women; mean age, 39.3 years) after receipt of a generic anti-seizure drug. The earliest claim for a new eslicarbazepine acetate or brivaracetam prescription served as the index date. As key inclusion criteria, the researchers used only one generic anti-seizure drug in the 12 months prior to the index date and one or more medical claims with a focal seizure diagnosis.

Results showed numerically greater decreases in all-cause and focal seizure-linked inpatient hospitalizations and outpatients visits, as well as in focal seizure-linked ED visits, among patients in the eslicarbazepine acetate group. Compared with those who initiated brivaracetam, those treated with eslicarbazepine acetate had significantly bigger declines in total charges of $3,446 (95% CI, $13,716 to $425), as well as in medical charges of $3,166 (95% CI, $13,991 to $323) for all-cause and of $2,969 (95% CI, $21,547 to $842) for focal seizure-linked charges. The researchers reported a reduction in all-cause outpatient charges of $3,397 (95% CI, $15,676 to $818) and in focal seizure-linked outpatient charges of $2,863 (95% CI, $19,707 to $787), as well as a reduction of $420 (95% CI, $1,058 to $78) in prescription charges unrelated to focal seizures.

“These data may help clinicians make prudent prescribing decisions and enable payers to develop evidence-based utilization policies,” Mehta and colleagues wrote.