Comparative economic outcomes in patients with focal seizures initiating eslicarbazepine acetate versus brivaracetam in the long-term care setting in the USA
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: To compare all-cause and epilepsy-specific pharmacy and total costs associated with initiation of eslicarbazepine acetate (ESL) or brivaracetam (BRV) among patients with focal seizures in long-term care (LTC) in the US. Methods: This retrospective analysis used data from IQVIA's New Data Warehouse. Results: 298 patients initiated ESL and 282 patients initiated BRV. Initiation of ESL versus BRV was associated with 33.3% lower all-cause pharmacy costs, 34.4% lower epilepsy-specific pharmacy costs, 21.3% lower all-cause total costs and 30.9% lower epilepsy-specific total costs (all p < 0.0001). Conclusion: Among patients with focal seizures in LTC in the US, initiation of ESL versus BRV was associated with significant reductions in all-cause and epilepsy-specific pharmacy and total costs compared with initiation of BRV.
Supplementary Material
File (supplementary materials.docx)
- Download
- 1.48 MB
References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Beghi E, Giussani G. Aging and the epidemiology of epilepsy. Neuroepidemiology 51, 216–223 (2018).
2.
Sirven JI. Epilepsy: a spectrum disorder. Cold Spring Harb. Perspect. Med. 5, a022848 (2015).
3.
Centers for Disease Control and Prevention. 2019 epilepsy prevalence in the United States. (2022). www.cdc.gov/epilepsy/data/index.html (Accessed 14 July 2022).
4.
Falco-Walter JJ, Scheffer IE, Fisher RS. The new definition and classification of seizures and epilepsy. Epilepsy Res. 139, 73–79 (2018).
5.
Sarmast ST, Abdullahi AM, Jahan N. Current classification of seizures and epilepsies: scope, limitations and recommendations for future action. Cureus 12(9), e10549 (2020).
6.
Hauser WA, Annegers JF, Kurland LT. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935–1984. Epilepsia 34(3), 453–458 (1993).
7.
Wirrell EC, Grossardt BR, Wong-Kisiel L. Incidence and classification of new-onset epilepsy and epilepsy syndromes in children in Olmsted County, Minnesota from 1980–2004: a population-based study. Epilepsy Res. 95(1-2), 110–118 (2011).
8.
Löscher W, Klein P. The pharmacology and clinical efficacy of antiseizure medications: from bromide salts to cenobamate and beyond. CNS Drugs 35, 935–963 (2021).
9.
Fitch K, Pan X, Lau J et al. Prevalence and economic burden of epilepsy in the institutionalized medicare fee-for-service population. Am. Health Drug Benefits 12(3), 151–158 (2019).
10.
Kanner AM, Bicchi MM. Antiseizure medications for adults with epilepsy: a review. JAMA 327(13), 1269–1281 (2022).
11.
Hakami T. Efficacy and tolerability of antiseizure drugs. Ther. Adv. Neurol. Disord. 14, 1–21 (2021).
12.
Gidal BE, French JA, Grossman P, Le Teuff G. Assessment of potential drug interactions in patients with epilepsy. Impact of age and sex. Neurology 72(5), 419–425 (2009).
13.
Aptiom. Prescribing information. Sunovion Pharmaceuticals Inc. (2013). www.aptiom.com/Aptiom-Prescribing-Information.pdf?_ga=2.26693117.114043104.1658109087-1842791351.1658109087 (Accessed 17 July 2022).
14.
Briviact. Prescribing information. UCB Inc (2016). www.briviact.com/briviact-PI.pdf (Accessed 17 July 2022).
15.
Feyissa AM. Brivaracetam in the treatment of epilepsy: a review of clinical trial data. Neuropsychiatr. Dis. Treat. 15, 2587–2600 (2019).
16.
Lattanzi S, Brigo F, Cagnetti C et al. Eslicarbazepine acetate in the treatment of adults with partial-onset epilepsy: an evidence-based review of efficacy, safety and place in therapy. Core Evid. 13, 21–31 (2018).
17.
Ben-Menachem E, Gabbai AA, Hufnagel A, Maia J, Almeida L, Soares-da-Silva. Eslicarbazepine acetate as adjunctive therapy in adult patients with partial epilepsy. Epilepsy Res. 89, 278–285 (2010).
18.
Elger C, Halasz P, Maia J, Almeida L, Soares-Da-Silva P. Efficacy and safety of eslicarbazepine acetate as adjunctive treatment in adults with refractory partial-onset seizures: a randomized, double-blind, placebo-controlled, parallel-group phase III study. Epilepsia 50, 454–463 (2009).
19.
Gil-Nagel A, Lopes-Lima J, Almeida L, Maia J, Soares-Da-Silva P. Efficacy and safety of 800 and 1200 mg eslicarbazepine acetate as adjunctive treatment in adults with refractory partial-onset seizures. Acta Neurol. Scand. 120, 281–287 (2009).
20.
Ryvlin P, Werhahn KJ, Blaszczyk B, Johnson ME, Lu S. Adjunctive brivaracetam in adults with uncontrolled focal epilepsy: results from a double-blind, randomized, placebo-controlled trial. Epilepsy. 55(1), 47–56 (2014).
21.
Biton V, Berkovic SF, Abou-Khalil B, Sperling MR, Johnson ME, Lu S. Brivaracetam as adjunctive treatment for uncontrolled partial epilepsy in adults: a phase III randomized, double-blind, placebo-controlled trial. Epilepsia 55(1), 57–66 (2014).
22.
Klein P, Schiemann J, Sperling MR et al. A randomized, double-blind, placebo-controlled, multicenter, parallel-group study to evaluate the efficacy and safety of adjunctive brivaracetam in adult patients with uncontrolled partial-onset seizures. Epilepsia 56(12), 1890–1898 (2015).
23.
Hixson J, Gidal B, Pikalov A et al. Efficacy and safety of eslicarbazepine acetate as a first or later adjunctive therapy in patients with focal seizures. Epilepsy Res. 171, 106561 (2021).
• This phase IV, open-label, non-randomized study showed that among adults with focal seizures in the USA and Canada who were treated with eslicarbazepine acetate (ESL) as first adjunctive therapy to levetiracetam (LEV) or lamotrigine (LTG) monotherapy (n = 36) or ESL as later adjunctive therapy (n = 37), ESL was effective and tolerable both as first adjunctive therapy to LEV or LTG and as a later adjunctive therapy.
24.
Villanueva V, Serratosa JM, Guillamón E et al. Long-term safety and efficacy of eslicarbazepine acetate in patients with focal seizures: results of the 1-year ESLIBASE retrospective study. Epilepsy Res. 108(7), 1243–1252 (2014).
• Among patients with focal seizures (FS) receiving eslicarbazepine acetate (ESL) in 12 hospitals in Spain, seizure frequency (obtained through clinical diaries), adverse events, and changes in concomitant antiseizure medications were retrospectively recorded in the ESLIBASE study, and the 12-month responder rate was 49.8% for those who had poor seizure control at baseline, and 20% of these patients were seizure-free, suggesting that ESL addition to patients already receiving other antiseizure medications could reduce seizure frequency by at least 50% from baseline after 12 months.
25.
Lattanzi S, Canafoglia L, Canevini MP et al. Adjunctive brivaracetam in focal epilepsy: real-world evidence from the brivaracetam add-on first Italian network study (BRIVAFIRST). CNS Drugs. 35(12), 1289–1301 (2021).
• In the BRIVAFIRST retrospective study conducted across 62 Italian centers on patients with focal seizures being treated with one or more antiseizure medications along with adjunctive brivaracetam (BRV) for at least 12 months (median doses of 100, 150 and 150 mg at 3, 6 and 12 months, respectively), 16.4% patients were seizure free and 37.2% patients had their seizure frequency reduced by 50% or more compared to baseline.
26.
Mehta D, Shah D, Desai V et al. Healthcare resource utilization among patients with focal seizures treated with eslicarbazepine acetate in the us long-term care setting: a retrospective claims database analysis. Neurol. Ther. 10(2), 673–691 (2021).
27.
Mehta D, Davis M, Epstein AJ et al. Comparative economic outcomes in patients with focal seizures initiating eslicarbazepine acetate versus brivaracetam as their first adjunctive ASD. J. Med. Econ. 24(1), 939–948 (2021).
•• Retrospective analysis of data from Symphony Health's Integrated Dataverse database (April 2015–June 2018) on patients with focal seizures who initiated eslicarbazepine acetate (ESL) (n = 208) or brivaracetam (BRV) (n = 137) as first adjunctive treatment to a single other baseline antiseizure medication showed that adjunctive ESL use had an economic benefit compared to adjunctive BRV use.
28.
Mehta D, Davis M, Epstein AJ, Wensel B, Grinnell, Williams RG. Comparative economic outcomes in patients with focal seizure initiating first-line eslicarbazepine acetate monotherapy versus generic antiseizure drugs. Clinicoecon. Outcomes Res. 13, 251–261 (2021).
29.
The United States Department of Health and Human Services. Summary of the HIPAA Privacy Rule. (2022). https://www.hhs.gov/sites/default/files/privacysummary.pdf (Accessed 14 July 2022).
30.
Birnbaum AK, Leppik IE, Svensden K, Eberly LE. Prevalence of epilepsy/seizures as a comorbidity of neurologic disorders in nursing homes. Neurology 88(8), 750–757 (2017).
31.
Toledano R, Jovel CE, Jiménez-Huete A et al. Efficacy and safety of eslicarbazepine acetate monotherapy for partial-onset seizures: experience from a multicenter, observational study. Epilepsy Behav. 73, 173–179 (2017).
32.
Trinka E, Ben-Menachem E, Kowacs PA et al. Efficacy and safety of eslicarbazepine acetate versus controlled-release carbamazepine monotherapy in newly diagnosed epilepsy: a phase III double-blind, randomized, parallel-group, multicenter study. Epilepsia 59, 479–491 (2018).
33.
Galiana GL, Gauthier AC, Mattson RH. Eslicarbazepine acetate: a new improvement on a classic drug family for the treatment of partial-onset seizures. Drugs R. D. 17, 329–339 (2017).
34.
Maher RL, Hanlon JT, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin. Drug Saf. 13(1), 57–65 (2014).
35.
Lloyd-Smith A, Hennessy R, Hegde M et al. Comparison of levetiracetam versus sodium channel blockers as first line antiseizure drug in participants with high seizure burden using human epilepsy project data. Am. Epilepsy Soc. Annu. Meeting 2016., Abstract 2.103 (2016).
36.
Mehta D, Azimpour K, Tremblay G et al. Network Meta-analysis comparing the psychiatric -emergent treatment adverse events associated with eslicarbazepine acetate and brivaracetam. Am. Epilepsy Soc. Conf. Proc., Accepted for presentation at AES 2020 (2020).
37.
Lattanzi S, Trinka E, Zaccara G et al. Third-generation antiseizure medications for adjunctive treatment of focal-onset seizures in adults: a systematic review and network meta-analysis. Drugs 82(2), 199–218 (2022).
•• A network meta-analysis of randomized controlled trials comparing oral brivaracetam (BRV), cenobamate (CNB), eslicarbazepine acetate (ESL), lacosamide (LSM) and perampanel (PER) showed that adjunctive CNB had a higher responder rate and the greatest likelihood ranking best for achieving seizure freedom compared to add-on BRV, ESL, LCM and PER.
38.
Pennington M, Prince E, Bateman N et al. Factors influencing the costs of epilepsy in adults with an intellectual disability. Seizure 21, 205–210 (2011).
• Intellectual disability (ID) is a common comorbidity of epilepsy and this prospective study assessing the health and social care costs of managing adults with epilepsy and ID in the community setting in the UK showed that ID increases the costs of epilepsy management, with perception of caregivers of a worse health state being a significant determinant of epilepsy health care utilization.
39.
Leppik IE. Epilepsy in the elderly. Epilepsia 47, 65–70 (2006).
• Polypharmacy is common among elderly patients with epilepsy, making it extremely important to consider age when choosing an antiseizure medication; moreover, lack of drug interactions and better safety profile may offset the additional costs of treatment with newer antiseizure medications compared to older ones.
40.
Watkins L, O'Dwyer M, Kerr M, Scheepers M, Courtenay K, Shankar R. Quality improvement in the management of people with epilepsy and intellectual disability: the development of clinical guidance. Expert Opin. Pharmacother. 21(2), 173–181 (2020).
41.
Lee SK. Epilepsy in the elderly: treatment and consideration of comorbid diseases. J. Epilepsy Res. 9(1), 27–35 (2019).
42.
Gupta DK, Bhoi SK, Kalita J, Misra UK. Hyponatremia following esclicarbazepine therapy. Seizure 29, 11–14 (2015).
43.
Willems LM, Zöllner JP, Paule E, Schubert-Bast S, Rosenow F, Strzelczyk A. Eslicarbazepine acetate in epilepsies with focal and secondary generalised seizures: systematic review of current evidence. Expert Rev. Clin. Pharmacol. 11(3), 309–324 (2018).
44.
Intravooth T, Staack AM, Juerges K, Stockinger J, Steinhoff BJ. Antiepileptic drugs-induced hyponatremia: review and analysis of 560 hospitalized patients. Epilepsy Res. 143, 7–10 (2018).
45.
Mehta D, Davis M, Epstein AJ et al. Impact of early initiation of eslicarbazepine acetate on economic outcomes among patients with focal seizure: results from retrospective database analyses. Neurol. Ther. 9(2), 585–598 (2020).
46.
Strzelczyk A, Zaveta C, von Podewils F et al. Long-term efficacy, tolerability, and retention of brivaracetam in epilepsy treatment: a longitudinal multicenter study with up to 5 years of follow-up. Epilepsia 62(12), 2994–3004 (2021).
47.
Arnold S, Badalamenti V, Diaz A et al. Conversion to brivaracetam monotherapy for the treatment of patients with focal seizures: two double-blind, randomized, multicenter, historical control, phase III studies. Epilepsy Res. 141, 73–82 (2018).
48.
Jacobson MP, Pazdera L, Bhatia P, Grinnell T, Cheng H, Blum D. Efficacy and safety of conversion to monotherapy with eslicarbazepine acetate in adults with uncontrolled partial-onset seizures: a historical-control phase III study. BMC Neurology. 15 46 (2015).
49.
Sperling MR, Harvey J, Grinnell T, Cheng H, Blum D. Efficacy and safety of conversion to monotherapy with eslicarbazepine acetate in adults with uncontrolled partial-onset seizures: a randomized historical-control phase III study based in North America. Epilepsia 56(4), 546–555 (2015).
50.
Jalihal V, Shankar R, Henley W et al. Eslicarbazepine acetate as a replacement for levetiracetam in people with epilepsy developing behavioral adverse events. Epilepsy Behav. 80, 365–369 (2018).
51.
Mehta D, Davis M, Epstein AJ, Wensel B, Thach A, Williams GR. Comparative economic outcomes in patients with focal seizure initiating eslicarbazepine acetate versus brivaracetam after switching from generic antiseizure drug. Presented at ISPOR 2022, May 15–18 (2022).
Information & Authors
Information
Published In
Pages: 1293 - 1308
PubMed: 36331060
Copyright
© 2022 The Authors. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 23 September 2022
Accepted: 21 October 2022
Published online: 4 November 2022
Keywords:
Topics
Authors
Funding Information
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Comparative economic outcomes in patients with focal seizures initiating eslicarbazepine acetate versus brivaracetam in the long-term care setting in the USA. (2022) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2022-0170
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Wei Jing, Meizhen Sun, Chao Yan, Antiseizure Medications, Pharmacological Treatment of Epileptic Seizures, 10.1007/978-981-96-8520-2_2, (59-327), (2025).
- Walter Garcia-Ubbelohde, Lia Pizzicato, Keith J Boesen, Swapna Munnangi, Liucheng Shi, Nicholas B. Hurst, Mitchell DeKoven, Cost comparison of F(ab’) 2 and Fab antivenoms for pit viper envenomation in the United States: a real-world analysis , Expert Review of Pharmacoeconomics & Outcomes Research, 10.1080/14737167.2025.2462236, 25, 5, (721-728), (2025).