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Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland.
Adv Ther 2020; 37(1):477-500AT

Abstract

INTRODUCTION

There is an unmet need for well-tolerated antiepileptic drugs (AEDs) that effectively control focal onset seizures. This study aimed to evaluate the economic value of new AEDs in the treatment of focal onset seizure, with or without secondary generalization, in Finnish adults and adolescents with epilepsy, comparing brivaracetam with perampanel as adjunctive AEDs.

METHODS

Economic value was assessed using cost-utility analysis. Periods of AED initiation, titration, response assessment (seizure freedom, ≥ 50% reduction, no response), switching in no response or treatment-emergent adverse events (TEAEs), and death were simulated using a discrete-event simulation model. Responses and switching were simulated based on a comprehensive Bayesian network meta-analysis. The primary modeled outcome was the 3%/year discounted incremental cost-effectiveness ratio (ICER). Discounted quality-adjusted life-years (QALYs), payer costs (year 2017 Euro) per patient, and net monetary benefit (NMB) were secondary outcomes. Probabilistic and comprehensive deterministic sensitivity analyses were conducted.

RESULTS

Brivaracetam was more efficacious and had fewer TEAEs than perampanel and other AEDs. Modeled average 5-year QALYs and costs were 3.671 and €28,297 for brivaracetam and 3.611 and €27,979 for perampanel, respectively. The resulting ICER for brivaracetam versus perampanel was only €5345/QALY gained in a deterministic base case scenario. Brivaracetam had a positive NMB and high probability of cost-effectiveness of €1190 and 71% or €1944 and 80% with the assumed willingness to pay of €25,358 or €38,036/QALY gained, respectively. The primary result was robust, with a positive NMB persistent in all sensitivity analysis scenarios. When switching from brivaracetam to perampanel was excluded from the modeling or switching from perampanel to brivaracetam was included, brivaracetam was cost-saving and more effective than perampanel (dominant).

CONCLUSION

These simulated comparisons demonstrated that brivaracetam was more effective and potentially also more affordable than perampanel. Thus, brivaracetam is likely a cost-effective and net beneficial alternative to perampanel for treatment of focal onset seizures. Plain language summary available for this article.

Authors+Show Affiliations

ESiOR Oy, Kuopio, Finland.ESiOR Oy, Kuopio, Finland. erkki.soini@esior.fi.Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland. Department of Neurology, Tampere University Hospital, Tampere, Finland.UCB Pharma Belgium, Brussels, Belgium.UCB Pharma Oy Finland, Espoo, Finland.Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. Epilepsy Center, Neurocenter, Kuopio University Hospital, Member of the European Reference Network for Rare and Complex Epilepsies EpiCARE, Kuopio, Finland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31808053

Citation

Väätäinen, Saku, et al. "Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland." Advances in Therapy, vol. 37, no. 1, 2020, pp. 477-500.
Väätäinen S, Soini E, Peltola J, et al. Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland. Adv Ther. 2020;37(1):477-500.
Väätäinen, S., Soini, E., Peltola, J., Charokopou, M., Taiha, M., & Kälviäinen, R. (2020). Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland. Advances in Therapy, 37(1), pp. 477-500. doi:10.1007/s12325-019-01155-6.
Väätäinen S, et al. Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland. Adv Ther. 2020;37(1):477-500. PubMed PMID: 31808053.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic Value of Adjunctive Brivaracetam Treatment Strategy for Focal Onset Seizures in Finland. AU - Väätäinen,Saku, AU - Soini,Erkki, AU - Peltola,Jukka, AU - Charokopou,Mata, AU - Taiha,Maarit, AU - Kälviäinen,Reetta, Y1 - 2019/12/05/ PY - 2019/10/03/received PY - 2019/12/7/pubmed PY - 2019/12/7/medline PY - 2019/12/7/entrez KW - Brivaracetam KW - Economic evaluation KW - Epilepsy KW - Focal onset seizure KW - PICOSTEPS KW - Perampanel SP - 477 EP - 500 JF - Advances in therapy JO - Adv Ther VL - 37 IS - 1 N2 - INTRODUCTION: There is an unmet need for well-tolerated antiepileptic drugs (AEDs) that effectively control focal onset seizures. This study aimed to evaluate the economic value of new AEDs in the treatment of focal onset seizure, with or without secondary generalization, in Finnish adults and adolescents with epilepsy, comparing brivaracetam with perampanel as adjunctive AEDs. METHODS: Economic value was assessed using cost-utility analysis. Periods of AED initiation, titration, response assessment (seizure freedom, ≥ 50% reduction, no response), switching in no response or treatment-emergent adverse events (TEAEs), and death were simulated using a discrete-event simulation model. Responses and switching were simulated based on a comprehensive Bayesian network meta-analysis. The primary modeled outcome was the 3%/year discounted incremental cost-effectiveness ratio (ICER). Discounted quality-adjusted life-years (QALYs), payer costs (year 2017 Euro) per patient, and net monetary benefit (NMB) were secondary outcomes. Probabilistic and comprehensive deterministic sensitivity analyses were conducted. RESULTS: Brivaracetam was more efficacious and had fewer TEAEs than perampanel and other AEDs. Modeled average 5-year QALYs and costs were 3.671 and €28,297 for brivaracetam and 3.611 and €27,979 for perampanel, respectively. The resulting ICER for brivaracetam versus perampanel was only €5345/QALY gained in a deterministic base case scenario. Brivaracetam had a positive NMB and high probability of cost-effectiveness of €1190 and 71% or €1944 and 80% with the assumed willingness to pay of €25,358 or €38,036/QALY gained, respectively. The primary result was robust, with a positive NMB persistent in all sensitivity analysis scenarios. When switching from brivaracetam to perampanel was excluded from the modeling or switching from perampanel to brivaracetam was included, brivaracetam was cost-saving and more effective than perampanel (dominant). CONCLUSION: These simulated comparisons demonstrated that brivaracetam was more effective and potentially also more affordable than perampanel. Thus, brivaracetam is likely a cost-effective and net beneficial alternative to perampanel for treatment of focal onset seizures. Plain language summary available for this article. SN - 1865-8652 UR - https://www.unboundmedicine.com/medline/citation/31808053/Economic_Value_of_Adjunctive_Brivaracetam_Treatment_Strategy_for_Focal_Onset_Seizures_in_Finland L2 - https://dx.doi.org/10.1007/s12325-019-01155-6 DB - PRIME DP - Unbound Medicine ER -