Article

Cost-Effectiveness of Brivaracetam As Adjunctive Therapy for Partial-Onset Epilepsy In The Finnish Setting

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  • ESiOR Oy
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... The economic value of brivaracetam was assessed with cost-utility analysis using a discrete event simulation model (DESM) developed for this purpose (see Charokopou et al. [32] and Väätäinen et al. [33]). The present analysis is based on the health economic analysis submitted as part of an application of the reasonable wholesale price and reimbursement for brivaracetam in Finland (previously reported as poster presentation; Väätäinen et al. [33]). ...
... The economic value of brivaracetam was assessed with cost-utility analysis using a discrete event simulation model (DESM) developed for this purpose (see Charokopou et al. [32] and Väätäinen et al. [33]). The present analysis is based on the health economic analysis submitted as part of an application of the reasonable wholesale price and reimbursement for brivaracetam in Finland (previously reported as poster presentation; Väätäinen et al. [33]). Thus, it is in line with the official cost-effectiveness analysis guideline by the Finnish Pharmaceuticals Pricing Board [34], a health technology assessment guideline by the Finnish Medicines Agency [35], recent work by the national Current Care treatment guideline working group [36], and evidence-based medicine. ...
... Individual patient-based DESM with Microsoft Excel user interface and R (v. 3.2.1) statistical software engine was used to simulate the comparison and to capture all relevant data and clinically meaningful events based on clinical consultation with neurologists specializing in epilepsy ( Fig. 1; see also Charokopou et al. [32], Väätäinen et al. [33]). The DESM generated a virtual cohort of 20,000 epilepsy patients with focal onset seizures, each of whom followed an individualized clinical pathway according to their time-dependent characteristics, response to each treatment (treatment history), and risk of other events. ...
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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 Plain language summary available for this article.
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