OBJECTIVES: In clinical trials, adjunctive cenobamate significantly reduced seizure frequency in patients with uncontrolled focal seizures, with a number of patients achieving 100% seizure reduction (zero seizures). This analysis evaluates the budget impact of adding cenobamate to hypothetical Medicaid and US commercial health plan formularies for the treatment of uncontrolled prevalent focal epilepsy.

METHODS: A 1-year budget impact model was developed for a target population of adults with uncontrolled prevalent focal epilepsy currently receiving branded antiseizure medications (ASMs). The model assessed the impact of cenobamate’s formulary introduction through pharmacy and medical spend, particularly the reduction of healthcare resource use due to improved seizure control. Target population inputs were taken from published studies on US epilepsy prevalence among commercial and Medicaid plans. Seizure control inputs were projected from an indirect treatment comparison of branded ASM (brivaracetam, eslicarbazepine acetate, lacosamide, perampanel) clinical trials. A survey was used to estimate the relationship between seizure frequency and healthcare resource use. Costs were estimated from RedBook and the Medicare Fee Schedule.

RESULTS: The base case assumed 1,000,000 covered lives (73% adult population) and results were generated for both Commercial and Medicaid plans. After applying epidemiology filters, the target population was estimated to be 347 and 1,405 patients, respectively. Assuming a 2.6% uptake for 2021, cenobamate led to a projected plan savings of $15,288 and $62,065, and an incremental per-member per-month savings of $0.001 and $0.005, respectively. Potential savings were driven by a larger offset of medical spend, specifically a reduction in inpatient hospitalizations.

CONCLUSIONS: The strong efficacy profile of cenobamate versus branded ASMs, based on an indirect treatment comparison, resulted in potential reductions in inpatient hospitalizations, emergency room visits, and provider visits. The nominal increase in pharmacy spend was balanced by a reduction in healthcare utilization costs, mostly due to fewer inpatient hospitalizations. Supported by SK Life Science, Inc.