Cost-effectiveness analysis of cenobamate for epilepsy patients with drug-resistant focal onset seizures in the Netherlands

OBJECTIVE: To assess the cost-effectiveness of cenobamate in epileptic people with focal seizures in the Netherlands. METHODS: A Markov model was used to simulate lifetime costs and quality-adjusted life years (QALYs) for cenobamate compared to perampanel, brivaracetam, and lacosamide from the Dutch societal perspective. Data from a randomized controlled trial and open-label extension were used to determine the transition probability, efficacy and safety of treatment with cenobamate. Treatment, administration, routine monitoring, seizure event management, adverse events and productivity costs were included. Both one-way and probabilistic sensitivity analyses were conducted to explore the uncertainty. RESULTS: Cenobamate was associated with an average total cost of €466,560 and 9.922 QALY gained. Among the four drugs tested, treatment with cenobamate indicated lowest cost and highest QALY gained, suggesting cenobamate dominates all comparators. One-way sensitivity analysis confirms the robustness of our results. Probabilistic sensitivity analyses revealed that at the willingness to pay threshold of €50,000/QALY, the probability that cenobamate is cost-effective was 100%. CONCLUSION: With the acknowledgment of the limitations, we concluded that cenobamate is less costly and more effective, which can be considered a cost-effective treatment option for patients with drug-resistant focal seizures in the Netherlands. Future real-world data are needed to confirm our findings.