OBJECTIVES: To estimate health outcomes and financial impact to a private healthcare payer of adoption of cenobamate into clinical practice for patients with refractory partial-onset epilepsy.

METHODS: We developed a 1-year budget impact model from the U.S. private payer perspective, which included a cohort of adult refractory partial epilepsy patients taking adjunctive lacosamide, perampanel, brivaracetam, eslicarbazepine acetate, or cenobamate as they experience clinical events and accrue health resource use and costs. The model explicitly incorporates costs of provider and emergency room visits along with inpatient hospitalizations as a function of estimates of seizure reduction garnered from the drugs’ Phase III trials. Costs were estimated from the 2018 Medicare Fee Schedule, which were inflated to represent private payer reimbursement.

RESULTS: Base case model assumed a hypothetical private health plan with 1,000,000 covered lives, with 77% adults (18+ years). After applying prevalence estimates, the final population represented 0.2% of total covered lives. Base case results suggest that, after introduction of cenobamate, at 17% uptake, the plan is exposed to 281 fewer provider visits, 49 fewer ER visits, and 55 fewer hospitalizations. Use of cenobamate led to cost savings of over $827,000, representing a $0.07 per-member per-month reduction in total plan costs. We conducted a one-way sensitivity analyses series to test the impact of key assumptions on plan savings after introduction of cenobamate. While the magnitude of cost savings varied, particularly as the uptake assumption was varied, the results directionality remained consistent, indicating improved effectiveness and economic efficiency upon introduction of cenobamate.

CONCLUSIONS: The results of this model demonstrate use of cenobamate in patients with refractory partial-onset epilepsy leads to reductions in healthcare resource use, driven by better clinical outcomes based on results published in the literature. Consequently, payers can expect moderate cost savings over a one-year time horizon.