LACOSAMIDE AS FIRST LINE TREATMENT OPTION IN FOCAL EPILEPSY; A COST-UTILITY ANALYSIS FOR THE GREEK HEALTHCARE SYSTEM
Author(s)
Geitona M1, Stamuli E2, Giannakodimos S3, Kimiskidis V4, Kountouris V5, Charokopou M6, Christou P5
1University of Peloponnese, Korinthos, Greece, 2University of York, York, UK, 3KOL, Athens, Greece, 4Aristotle University of Thessaloniki, Thessaloniki, Greece, 5UCB Pharma, Athens, Greece, 6UCB Pharma, Brussels, Belgium
OBJECTIVES: Approximately 30% of patients with focal epileptic seizures remain uncontrolled after the first epileptic treatment. Lacosamide (LCM) has been recently approved by the European Medicines Agency as monotherapy option for the treatment of focal seizures. The objective of this study was to estimate the cost-effectiveness of LCM compared to zonisamide (ZNS) as first-line treatment of focal epilepsy in patients with epilepsy aged 16 years and older to inform clinical decision-making in Greece. METHODS: A previously developed discrete event simulation model was adapted to reflect the treatment pathway and resource use within the Greek national healthcare system, as specified by clinical experts. The model captures time-varying events and patient characteristics. Clinical inputs were sourced from pivotal trials and a network meta-analysis comparing LCM to other antiepileptic drugs (AEDs). The model predicts disease progression and seizures, relevant and most common adverse events, withdrawal due to lack of efficacy or adverse events, together with epilepsy-specific and all‑cause mortality over a 2-year time horizon. Unit costs were retrieved from officially published Greek sources. Health outcomes were measured as quality adjusted life years (QALYs). To demonstrate the robustness of the results, univariate and probabilistic sensitivity analyses were performed. RESULTS: LCM treatment pathway was associated with higher mean costs (€1,064) and additional 0.119 QALYs versus ZNS, resulting in an incremental cost effectiveness ratio of €8,938 per QALY gained. The sensitivity analyses demonstrated that the results are most sensitive to the efficacy and utility estimates, yet establishing the robustness of the outcomes. CONCLUSIONS: Lacosamide is shown to be a cost-effective option at a willingness to pay threshold of € 30,000 per QALY, hence represents a valuable monotherapy option for the treatment of patients with focal epileptic seizures.
Conference/Value in Health Info
2017-11, ISPOR Europe 2017, Glasgow, Scotland
Value in Health, Vol. 20, No. 9 (October 2017)
Code
PND40
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Neurological Disorders