Budget Impact Analysis of Cenobamate for Epilepsy Patients With Drug-Resistant Focal Onset Seizures in the Netherlands

OBJECTIVES: To explore the financial consequences of adopting cenobamate as a treatment alternative in epilepsy patients with drug-resistant focal onset seizures (FOS) from a societal perspective in the Netherlands.

METHODS: A previous budget impact model with a 5-year time horizon was adapted to the Dutch setting accounting for the eligible population, real-world market shares, treatment effectiveness and resource use in two scenarios: cenobamate with constant market share versus cenobamate with linearly increased market share up to 20%. Clinical inputs included treatment response, seizure reduction and adverse events. Costs consisted of drugs, medical and non-medical costs. One-way sensitivity analysis and scenario analysis were conducted to test the robustness of our results.

RESULTS: 14,723 patients were eligible for cenobamate in 2022. Although cenobamate adds €12,686,307 on the drug budget over 5 years, the reduction due to the replacement of three other drugs yields a total impact on the drug budget of €3,722,596. Adopting cenobamate resulted in a medical cost saving of €13,622,208 due to less resource use. Non-medical cost saving of €22,144,054 was associated with reductions in productivity due to focal epilepsy. Overall, savings generated at medical and non-medical cost level offset the impact of cenobamate on the drug budget, resulting in a budget saving of €32,043,665 over 5 years. Results were robust in the sensitivity/scenario analyses.

CONCLUSIONS: Treatment with cenobamate is associated with both medical and non-medical cost savings, which offset the increase in drug budget and result in a significant potential budget saving. The higher the market share of cenobamate, the larger the budget savings. We acknowledge several limitations; Complex scenarios such as drug interactions, stopping/switching drugs, and multiple drug use were not taken into account. The long-term efficacy and safety of cenabamate and its comparators remains uncertain. Future real-world data are needed to confirm our findings.