Objective:

To compare healthcare utilization outcomes for patients diagnosed with focal epilepsy and having cenobamate or one of 7 other newer antiseizure medications (ASMs) added to their treatment regimen.

Background:

Cenobamate is approved in the United States and Europe as a treatment for adults with focal onset seizures.

Design/Methods:

Patients with focal epilepsy [ICD-10-CM G40.0*-G40.2*] taking ≥1 ASM between 1/1/2017-12/31/2021 were identified retrospectively from the HealthVerity Marketplace Private Source 20 database. Adjudicated pharmacy claims from patients with at least 12 months of enrollment were included. Mixed-effect regressions estimated the association between ASM-specific new lines of therapy (LOT, defined as the retail pharmacy dispensing of an ASM after ≥30 days without a previous fill) and epilepsy-related inpatient stays and emergency room (ER) visits. We compared LOT adding cenobamate with those adding brivaracetam, clobazam, eslicarbazepine, lacosamide, lamotrigine, levetiracetam, or perampanel. 

Results:

58,786 patients (55.7% female, mean age=42.0 years) were exposed to 84,301 LOT. Overall LOT for ASMs ranged from 2069 for cenobamate (2062 patients) to 26,485 for lacosamide (25,889 patients). Over 116,859.2 person years, (>42.6 million total days of therapy), patients experienced 170.6 inpatient days and 41.0 ER visits per 100 patient-years. Compared with cenobamate, all other 7 ASMs demonstrated higher inpatient day rates and higher ER visit rates (all P≤0.001); this finding was consistent across focal epilepsy subgroups and was amplified in patients with prior admits. Relative to cenobamate, adjusted mean increases in inpatient days ranged from 1.7 (lamotrigine) to 6.4 (lacosamide) per 100 patient-years. Adjusted mean increases in ER visits vs cenobamate ranged from 2.0 (brivaracetam) to 8.8 (levetiracetam) per 100 patient-years. 

Conclusions: