Effectiveness of Cenobamate in Postsurgical Patients: A Retrospective Claims-based Analysis
Jacob Pellinen1, Clarence Wade2, Sean Stern2, Vernon Schabert3, Christopher Elder4
1University of Colorado School of Medicine, 2SK Life Science, Inc., 3Epilogix LLC, 4NYU Grossman School of Medicine
Objective:
To compare healthcare utilization outcomes for patients adding cenobamate or 7 other newer antiseizure medications (ASMs) to existing therapy regimens following surgical or neurostimulation therapy for seizure disorders.
Background:
Patients undergoing surgical treatment for epilepsy may continue to experience focal seizures.
Design/Methods:
Patients with epilepsy (ICD-10-CM G40*) 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 ≥12 months of enrollment were included. Mixed-effect regressions estimated the association between ASM-specific line of therapy (LOT; defined as the retail pharmacy dispensing of an ASM after ≥30 days without a previous fill) and epilepsy-related inpatient and emergency room (ER) visits in patients with prior evidence of epilepsy-related surgical resection or implantation of a vagus nerve stimulator or a responsive neurostimulation device. We compared LOT adding cenobamate with those adding brivaracetam, clobazam, eslicarbazepine, lacosamide, lamotrigine, levetiracetam, or perampanel.
Results:
7835 patients (52.4% female, mean age=39.3 years) were exposed to 11,771 LOT. Over 14,874.6 person-years (>5.4 million days of therapy), patients experienced 202.7 inpatient days and 47.3 ER visits per 100 person-years. Compared with cenobamate, all 7 other ASMs demonstrated higher ER rates. Six ASMs demonstrated higher inpatient day rates than cenobamate (all P≤0.001); eslicarbazepine demonstrated lower inpatient day rates (P<0.001). Relative to cenobamate, adjusted mean increases in ER visits per patient year ranged from 3.4 (brivaracetam) to 9.2 (levetiracetam) per 100 patient-years. Adjusted mean increases in inpatient days ranged from 0.004 (lamotrigine) to 10.3 (lacosamide) per 100 patient-years, with an adjusted mean decrease of 0.3 inpatient days per 100 patient-years for eslicarbazepine.
Conclusions:
Following surgery, cenobamate was associated with lower ER rates than 7 leading ASMs, and with lower inpatient days than all comparators except eslicarbazepine, suggesting that improved seizure control with cenobamate may provide significant cost savings and reductions in seizure-related morbidity and mortality.