Q&A: Study examines 'downstream economic burden' of adjunctive therapy in epilepsy

Findings published recently in Journal of Medical Economics demonstrated that patients with focal seizures who began first adjunctive therapy with eslicarbazepine acetate vs. brivaracetam had considerably larger reductions in medical costs.

Those patients also experienced decreases in prescription charges unrelated to anti-seizure drugs, according to the study results.

“[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],” the researchers wrote. “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 and as later adjunctive therapy in treatment-resistant patients.”

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 collected 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 (FS), by shedding light on differences in health care resource utilization between these drugs.

Healio Neurology spoke with G. Rhys Williams, ScD, vice president of global health economics and outcomes research at Sunovion, to learn more about the study results and the potential implications for clinicians and patients.

Healio Neurology: What prompted this research?

Williams: Epilepsy is one of the most common neurological diseases globally, affecting approximately 50 million people worldwide. The condition is characterized by unpredictable seizures, which are caused by disturbances in the electrical activity in the brain.

Partial-onset or FS are characterized by bursts of electrical activity that are initially focused in a specific area or network on one side of the brain and may become more widespread, with symptoms varying according to the affected areas. FS constitute an estimated 60% of epilepsy cases. Despite the approval of many anti-seizure drugs (ASDs), 50% of individuals with epilepsy continue to experience seizers following initial monotherapy. Therefore, the use of additional or adjunctive therapies — with the goal of helping reduce the frequency of an individual’s seizures — are common among these patients.

The purpose of this retrospective, longitudinal cohort analysis was to look at the association between initiation of first adjunctive therapy with eslicarbazepine acetate (ESL) vs. brivaracetam (BRV) on health care resource utilization (HCRU) and charges among patients treated with FS.

Healio Neurology: Why is it important to study resource utilization among patients with epilepsy?

Williams: Patients with epilepsy incur substantial HCRU and costs. In general, for the epilepsy populations in the U.S., annual total direct health care costs ranged from $10,192 to $47,862 per patient, and epilepsy-specific costs ranged from $1,022 to $19,749 per patient. Therefore, getting a better understanding of the HCRU associated with the initiation of third-generation ASDs as first adjunctive therapy can help support clinical decision making by physicians, payers and patients, and reduce the economic burden associated with FS.

Healio Neurology: Can you provide a brief overview of the study results?

Williams: This retrospective, longitudinal cohort analysis looked at the HCRU from April 1, 2015, to June 30, 2018, among 208 and 137 adults living with FS initiating ESL and BRV as the first adjunctive ASD, respectively. Patients in the ESL cohort experienced numerically larger reductions in all-cause and FS-related inpatient hospitalizations and outpatient visits and FS-related emergency department visits.

Patients treated with ESL had significantly larger reductions in total charges ($3,446; 95% CI: $13,716 to $425), all-cause ($3,166; 95% CI, $13,991 to $323) and FS-related ($2,969; 95% CI, $21,547 to $842) medical charges, all-cause ($3,397; 95% CI, $15,676 to $818) and FS-related ($2,863; 95% CI, $19,707, $787) outpatient charges, and non-ASD-related prescription charges ($420; 95% CI, $1,058, $78) compared to patients initiating BRV.

Among patients with FS, initiation of first adjunctive therapy with ESL was associated with significantly larger reductions in medical and non-ASD-related prescriptions charges compared to BRV.

Healio Neurology: How can this information be useful in clinical practice?

Williams: The data published in Journal of Medical Economics provides health care providers, formulary decision makers and patients with a view of the overall downstream economic burden patients and health system might experience when prescribing ESL or BRV as the first adjunctive ASD.

Reference:

Mehta D, et al. J Med Econ. 2021;doi:10.1080/13696998.2021.1960682.