Comparative Economic Outcomes Among Patients with Epilepsy or Seizure Initiating Eslicarbazepine Acetate, Brivaracetam, or Lacosamide Early in the Treatment Cycle in the Long-term Care (LTC) Setting
Abstract number :
2.251
Submission category :
7. Anti-seizure Medications / 7C. Cohort Studies
Year :
2022
Submission ID :
2204783
Source :
www.aesnet.org
Presentation date :
12/4/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:26 AM
Authors :
Brian Wensel, Pharm D – Sunovion Pharmaceuticals Inc.; Darshan Mehta, PhD – Sunovion Pharmaceuticals Inc.; Inyoung Lee, PhD – IQVIA Inc.; Riddhi Doshi, PhD – IQVIA Inc.; Mitchell DeKoven, MHSA – IQVIA Inc.; Andrew Thach, PhD – Sunovion Pharmaceuticals Inc.; Gwilym Williams, PhD – Sunovion Pharmaceuticals Inc.
Rationale: To compare economic outcomes among patients with epilepsy or seizure initiating eslicarbazepine acetate (ESL), brivaracetam (BRV), or lacosamide (LCM) as their first or second observed anti-epileptic drug (AED) in the LTC setting.
Methods: This retrospective, longitudinal cohort analysis used IQVIA’s LTC claims linked to prescription (Rx) and professional fee (Dx) claims databases from 02/01/2015 to 03/31/2021. Patients were eligible for inclusion if they met the following criteria: (1) age ≥4 years at index date; (2) ≥1 prescription of oral ESL or BRV or LCM in the LTC pharmacy data at any time between 02/01/2016 to 03/31/2020; (3) diagnosis of seizure or epilepsy in Dx or Charge Data Master database (CDM) (4) a second prescription of the index AED during 12-months post-index period; (5) up to 1 other AED prescription in the baseline. Mutually exclusive cohorts were identified for pairwise comparisons (ESL vs BRV; ESL or LCM). Demographic and clinical characteristics were studied during the baseline period (12 months pre-index). Using generalized linear models, we compared all-cause and epilepsy-specific total and pharmacy costs among two mutually exclusive cohorts of ESL (n=351) versus BRV (n=141) and ESL (n=342) versus LCM (n=6,091) over the follow-up period (12 months post-index).
Results: Patients in ESL cohort were older (61.5 V. 55.5; p=0.0007), had higher prevalence of Alzheimer’s disease (33.9% V. 22%; p=0.0094), dementia (33.3% V. 19.9%; p=0.003) and lower baseline pharmacy cost than BRV users. Patients in ESL cohort were younger, had higher prevalence of Alzheimer’s disease (34.2% V. 28.7%; p=0.0283), dementia (33.6% V. 27.3%; p=0.0112) had significantly lower baseline pharmacy and total cost than LCM users. After adjusting for the baseline differences, compared to patients in BRV cohort, patients in ESL cohort incurred 37.1% lower all-cause total cost (cost ratio=0.63 [0.53-0.75]), 42.9% lower all-cause pharmacy cost (cost ratio=0.57 [0.48-0.68]), 50.2% lower total epilepsy-specific cost (cost ratio=0.48 [0.41-0.61]) and 49.8% lower total epilepsy-specific pharmacy cost (cost ratio=0.51 [0.41-0.62]). Compared to patients in LCM cohort, patients in ESL cohort incurred 29.6% lower all-cause total cost (cost ratio=0.70 [0.63-0.79]), 32.2% lower all-cause pharmacy cost (cost ratio=0.68 [0.61-0.76]), 31.7% lower total epilepsy-specific total cost (cost ratio=0.69 [0.61-0.77]) and 26.2% lower total epilepsy-specific pharmacy cost (cost ratio=0.74 [0.64-0.83]).
Conclusions: Among patients with epilepsy or seizure, initiation of ESL in LTC setting after up to one observed AED in the baseline was associated with significantly lower all-cause and epilepsy-specific total and pharmacy costs compared to BRV and LCM.
Funding: Sunovion Pharmaceuticals Inc.
Anti-seizure Medications