CENOBAMATE VERSUS VAGUS NERVE STIMULATION AND EPILEPSY SURGERY IN FOCAL DRUG-RESISTANT EPILEPSY: A COST-COMPARISON ANALYSIS IN THE UK NHS
Author(s)
Giorgio Di Dato, PharmD, MBA1, Raihaan Haq, PharmD1, Rajesh Vohra, Pharmacology1, Omar Madani, MSc2, Vicki Laskier-Owens, MSc2, Ben Llewellyn, MSc2.
1Angelini Pharma UKI, London, United Kingdom, 2Acumetis, London, United Kingdom.
1Angelini Pharma UKI, London, United Kingdom, 2Acumetis, London, United Kingdom.
OBJECTIVES: To quantify differences in healthcare resource utilisation (HCRU) and associated costs between pharmacological management with cenobamate and invasive procedures as vagus nerve stimulation (VNS) or epilepsy surgery (ES) in adults with focal drug-resistant epilepsy (DRE) from the UK NHS perspective.
METHODS: A cost-comparison tool was developed to model three pathways: cenobamate, VNS, and ES. Inputs were customisable to reflect local NHS settings. Pathway timings for VNS and ES were derived as averages from interviews with epileptologists (n=3): VNS (10-month waitlist, 16-month follow-up); ES (20-month waitlist, 6-month follow-up), resulting in a 26-month horizon. Costs were sourced from NHS tariffs. Clinical effectiveness was derived from literature, with seizure frequency outcomes categorized in: no change, ≥50% reduction, ≥75% reduction, and seizure freedom for cenobamate; no change, ≥50% and <100% reduction, and seizure freedom for VNS and ES. Scenario analyses were conducted to explore costs variation. The tool was initiated and funded by Angelini Pharma UKI Limited and developed by Acumetis.
RESULTS: Total 26-month per-patient costs were lowest for cenobamate (£8,935-£22,343), intermediate for VNS (£38,234-£50,493), and highest for ES (£100,709-£105,306). Cenobamate generated cost savings of £78,366-£96,371 per-patient versus ES and of £15,892-£42,558 versus VNS. In the VNS pathway, neurology departments bear most costs, while in ES costs are distributed approximately evenly across neurology and surgical departments, highlighting significant organisational impact beyond headline procedure costs.
CONCLUSIONS: The analysis demonstrates that earlier pharmacological intervention with cenobamate may reduce healthcare costs compared with invasive pathways in adults with focal DRE. The tool allows NHS decision-makers to adapt assumptions and support resource planning in epilepsy services. Given that ES is ultimately performed in only 41.3% of waitlisted patients and VNS seizure freedom rates are as low as 2.6%, the findings suggest that reallocation of resources warrants consideration within the NHS context.
METHODS: A cost-comparison tool was developed to model three pathways: cenobamate, VNS, and ES. Inputs were customisable to reflect local NHS settings. Pathway timings for VNS and ES were derived as averages from interviews with epileptologists (n=3): VNS (10-month waitlist, 16-month follow-up); ES (20-month waitlist, 6-month follow-up), resulting in a 26-month horizon. Costs were sourced from NHS tariffs. Clinical effectiveness was derived from literature, with seizure frequency outcomes categorized in: no change, ≥50% reduction, ≥75% reduction, and seizure freedom for cenobamate; no change, ≥50% and <100% reduction, and seizure freedom for VNS and ES. Scenario analyses were conducted to explore costs variation. The tool was initiated and funded by Angelini Pharma UKI Limited and developed by Acumetis.
RESULTS: Total 26-month per-patient costs were lowest for cenobamate (£8,935-£22,343), intermediate for VNS (£38,234-£50,493), and highest for ES (£100,709-£105,306). Cenobamate generated cost savings of £78,366-£96,371 per-patient versus ES and of £15,892-£42,558 versus VNS. In the VNS pathway, neurology departments bear most costs, while in ES costs are distributed approximately evenly across neurology and surgical departments, highlighting significant organisational impact beyond headline procedure costs.
CONCLUSIONS: The analysis demonstrates that earlier pharmacological intervention with cenobamate may reduce healthcare costs compared with invasive pathways in adults with focal DRE. The tool allows NHS decision-makers to adapt assumptions and support resource planning in epilepsy services. Given that ES is ultimately performed in only 41.3% of waitlisted patients and VNS seizure freedom rates are as low as 2.6%, the findings suggest that reallocation of resources warrants consideration within the NHS context.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE201
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Organizational Practices
Topic Subcategory
Budget Impact Analysis
Disease
Neurological Disorders